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General NPI Number Information
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NPI Number | 1568922151
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Entity Type | Individual
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Provider Name | ALAN R. MASSOUH MD
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Gender | Male
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 30 N 1900 E RM 1A071
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City | SALT LAKE CITY
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State | UT
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Zip | 84132-0002
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Country | US
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Telephone | 801-581-2868
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Fax |
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Provider Business Mailing Address
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Address Line | 111 COLCHESTER AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-1473
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Country | US
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Telephone | 802-847-0000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 042.0018520
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 11924132-1205
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 11924132-1205
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License Number State | UT
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