Provider Demographics
NPI:1063455053
Name:CASSENS, RODNEY L (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:L
Last Name:CASSENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-0328
Mailing Address - Country:US
Mailing Address - Phone:712-279-5830
Mailing Address - Fax:712-279-5883
Practice Address - Street 1:3500 SINGING HILLS BLVD
Practice Address - Street 2:STE 100
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-5127
Practice Address - Country:US
Practice Address - Phone:712-274-4250
Practice Address - Fax:712-274-4260
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1064345Medicaid
IA4064345Medicaid
IA09874OtherWELLMARK BCBS IA
IA1792OtherMIDLANDS CHOICE - BUSINES
IA7713090Medicaid
IA38306OtherWELLMARK - BUSINESS HEALT
IA10025201600Medicaid
IA42128384924Medicaid
IA10025201600Medicaid
IA7713090Medicaid
IA38306OtherWELLMARK - BUSINESS HEALT
IA4064345Medicaid