Provider Demographics
NPI:1649292053
Name:MASSEY, F. MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:F.
Middle Name:MITCHELL
Last Name:MASSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-1506
Mailing Address - Country:US
Mailing Address - Phone:662-844-5330
Mailing Address - Fax:662-841-2962
Practice Address - Street 1:808 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5749
Practice Address - Country:US
Practice Address - Phone:662-844-5330
Practice Address - Fax:662-841-2962
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06006207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS13293Medicaid
MS200011669Medicare PIN
MS200000064Medicare ID - Type Unspecified
MSB-64607Medicare UPIN
MS13293Medicaid
MS1649292053Medicare NSC