MEDICARE: DON MASSEY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA10001333	WA
2	363A00000X	Physician Assistant	PA10001333	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003873621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DON MASSEY PA-C

Provider Business Mailing Address
First Line	:	3908 10TH ST SE
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98374-2188
Country	:	US
Telephone Number	:	253-848-5951
Fax Number	:	253-845-7073

Provider Business Practice Location Address
First Line	:	10004 204TH AVE E
Second Line	:	#1200
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-6539
Country	:	US
Telephone Number	:	253-848-5951
Fax Number	:	253-845-7073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	04/10/2017

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Directions to “ DON MASSEY PA-C” Practice Location

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