Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 201480 | LA |
NPI | 1093828113 |
---|---|
Provider Name | Dr. Brett Michael Cascio |
First Address | Lake Charles, LA 70605 |
Second Address | Lake Charles, LA 70605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 15/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1015610 | (05) | LA |
I70286 | (02) | LA |