Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 138 | TX |
N | 222Z00000X | Podiatrist | 138 | TX |
N | 224P00000X | Prosthetist | 138 | TX |
N | 225X00000X | Occupational Therapist | 102390 | TX |
NPI | 1124008990 |
---|---|
Provider Name | Mr. Jonathan Cassens |
First Address | Bryan, TX 77802-2542 |
Second Address | Bryan, TX 77802-2542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22102 | SCOTT AND WHITE PROV ID (01) | TX |
515099 | BCBS PROVIDER ID (01) | TX |
CPO01811 | BOARD CERTIFICATION, ABC (01) |