Provider Demographics
NPI:1679578058
Name:MASSEY, BROOK THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:BROOK
Middle Name:THOMAS
Last Name:MASSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-633-4622
Mailing Address - Fax:502-633-6925
Practice Address - Street 1:60 MACK WALTERS RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1738
Practice Address - Country:US
Practice Address - Phone:502-633-4622
Practice Address - Fax:502-633-6925
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25606207Q00000X
KY34690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000023032TOtherHUMANA- NORTON
KY64346901Medicaid
KY3513870000OtherPASSPORT ADVANTAGE- NORTON CMA- TYLER CTR
AL515-25606OtherSHO BCBSAL
KY000000555430OtherANTHEM- NORTON
KY000000389694OtherANTHEM
KY50019322OtherPASSPORT- NCMA
AL051555189Medicaid
KY6434690100OtherMEDICAID KY- NORTON COMMUNITY MEDICAL ASSOCIATES
KY6434690100OtherMEDICAID KY- NORTON COMMUNITY MEDICAL ASSOCIATES
KY6434690100OtherMEDICAID KY- NORTON COMMUNITY MEDICAL ASSOCIATES
AL515-25606OtherSHO BCBSAL
ALBM6231156OtherDEA CERTIFICATE
KY000023032TOtherHUMANA- NORTON
KY00533026Medicare UPIN
KY000000389694OtherANTHEM