Provider Demographics
NPI:1114097748
Name:CASSIDY, JOHN W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:WAYNE
Other - Last Name:CASSIDY, PA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 RIVERWAY STE 700
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-1988
Mailing Address - Country:US
Mailing Address - Phone:713-355-6111
Mailing Address - Fax:713-355-6822
Practice Address - Street 1:1 RIVERWAY
Practice Address - Street 2:SUITE 600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-1920
Practice Address - Country:US
Practice Address - Phone:713-355-6111
Practice Address - Fax:713-355-6822
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH34502084B0040X, 2084N0400X, 2084P0005X, 2084P0800X, 2084P0301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury Medicine
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG130759OtherCALIFORNIA MEDICAL LICENSE
MA47995OtherMASSACHUSETTS MEDICAL LICENSE
TXH3450OtherTEXAS MEDICAL LICENSE