Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 213-000222 | IL |
N | 222Z00000X | Podiatrist | 213-000222 | IL |
Y | 224P00000X | Prosthetist | 211-000184 | IL |
NPI | 1205972049 |
---|---|
Provider Name | Marcus James Cassar |
First Address | Portland, OR 97201-3006 |
Second Address | Portland, OR 97201-3006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 10/09/2010 |