Healthcare Provider Details

I. General information

NPI: 1851463343
Provider Name (Legal Business Name): ALEXANDER HALSTEAD MASSEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 FOWLER WAY STE 4
PLACERVILLE CA
95667-5746
US

IV. Provider business mailing address

PO BOX 45680
SAN FRANCISCO CA
94145-0680
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-9488
  • Fax: 530-748-0320
Mailing address:
  • Phone: 530-626-9488
  • Fax: 530-748-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG78874
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG78874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: