MEDICARE: DR. ANTHONY MARK MASI M.D.

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	207RP1001X	Pulmonary Disease Physician	R3P21	MO
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	R3P21	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	290015378	OTHER	MO	RAILROAD MEDICARE

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	:	1902884844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY MARK MASI M.D.

Provider Business Mailing Address
First Line	:	13975 MANCHESTER RD
Second Line	:	SUITE 7
City	:	BALLWIN
State	:	MO
Zip	:	63011-4500
Country	:	US
Telephone Number	:	636-391-1222
Fax Number	:	636-333-1259

Provider Business Practice Location Address
First Line	:	13975 MANCHESTER RD
Second Line	:	SUITE 7
City	:	BALLWIN
State	:	MO
Zip	:	63011-4500
Country	:	US
Telephone Number	:	636-391-1222
Fax Number	:	636-333-1259

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

Provider Enumeration Date	:	12/31/2005
Last Update Date	:	06/06/2012

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