Provider Demographics
NPI:1861408866
Name:MASSEY, FRED M (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:M
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 1:7922 EWING HALSELL DR
Mailing Address - Street 2:SUITE #220
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3786
Mailing Address - Country:US
Mailing Address - Phone:210-614-9548
Mailing Address - Fax:210-616-0275
Practice Address - Street 1:7922 EWING HALSELL DR
Practice Address - Street 2:SUITE #220
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3786
Practice Address - Country:US
Practice Address - Phone:210-614-9548
Practice Address - Fax:210-616-0275
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3549207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5684625OtherAETNA
TX83Z205OtherBLUECROSS/BLUESHIELD TX.
TXD66895Medicare UPIN
TX83Z205Medicare ID - Type Unspecified