Provider Demographics
NPI:1114344025
Name:CASSERLY, RYAN M (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:CASSERLY
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 1:966 CASS ST STE 250
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4541
Mailing Address - Country:US
Mailing Address - Phone:831-649-4000
Mailing Address - Fax:
Practice Address - Street 1:966 CASS ST STE 250
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4541
Practice Address - Country:US
Practice Address - Phone:831-649-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA169329207YX0905X
DEC7-0007081207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery