Provider Demographics
NPI:1447453931
Name:G.P.MASSAND, M.D., P.C.
Entity type:Organization
Organization Name:G.P.MASSAND, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GHANSHYAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:MASSAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-789-1522
Mailing Address - Street 1:175 N 100 W
Mailing Address - Street 2:SUITE 204
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2049
Mailing Address - Country:US
Mailing Address - Phone:435-789-1522
Mailing Address - Fax:435-789-1524
Practice Address - Street 1:175 N 100 W
Practice Address - Street 2:SUITE 204
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2049
Practice Address - Country:US
Practice Address - Phone:435-789-1522
Practice Address - Fax:435-789-1524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6150961-1205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1740245604Medicaid
UTA59694Medicare UPIN
UT6017780001Medicare NSC
UT1740482025Medicare PIN