Provider Demographics
NPI:1427132133
Name:JOHN R. CASSIDY, M.D., P.A.
Entity type:Organization
Organization Name:JOHN R. CASSIDY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-484-3404
Mailing Address - Street 1:842 SUNSET LAKE BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-7551
Mailing Address - Country:US
Mailing Address - Phone:941-484-3404
Mailing Address - Fax:941-496-7895
Practice Address - Street 1:842 SUNSET LAKE BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7551
Practice Address - Country:US
Practice Address - Phone:941-484-3404
Practice Address - Fax:941-496-7895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAME0057567207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10392OtherFL BC/BS # FOR JRC
FLE60798Medicare UPIN
FL10392XMedicare ID - Type UnspecifiedMC INDIVIDUAL # FOR JRC
FLK7700Medicare ID - Type UnspecifiedMEDICARE GROUP # FOR JRC
FLP00231695Medicare ID - Type UnspecifiedRR MEDICARE # FOR JRC