Provider Demographics
NPI:1528132487
Name:CASSIDY, J BRENNAN (MD)
Entity type:Individual
Prefix:
First Name:J
Middle Name:BRENNAN
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3929 S BRISTOL ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7427
Mailing Address - Country:US
Mailing Address - Phone:714-662-0322
Mailing Address - Fax:714-662-0329
Practice Address - Street 1:3929 S BRISTOL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7427
Practice Address - Country:US
Practice Address - Phone:714-662-0322
Practice Address - Fax:714-662-0329
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC30247207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine