Provider Demographics
NPI:1861411183
Name:MASSEY, W. BOYD (MD)
Entity type:Individual
Prefix:DR
First Name:W.
Middle Name:BOYD
Last Name:MASSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:W.
Other - Middle Name:BOYD
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
Mailing Address - Street 1:1300 SUNSET DR
Mailing Address - Street 2:SUITE R
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4086
Mailing Address - Country:US
Mailing Address - Phone:662-227-1695
Mailing Address - Fax:662-226-6899
Practice Address - Street 1:1300 SUNSET DR
Practice Address - Street 2:SUITE R
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4086
Practice Address - Country:US
Practice Address - Phone:662-227-1695
Practice Address - Fax:662-226-6899
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07033207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00016817Medicaid
MSB30353Medicare UPIN