Provider Demographics
NPI:1376614107
Name:CASSELL, SIDNEY L I (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:L I
Last Name:CASSELL
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 1:132 E BROADWAY
Mailing Address - Street 2:SUITE 830
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3160
Mailing Address - Country:US
Mailing Address - Phone:541-687-0816
Mailing Address - Fax:541-687-1086
Practice Address - Street 1:132 E BROADWAY
Practice Address - Street 2:SUITE 830
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3160
Practice Address - Country:US
Practice Address - Phone:541-687-0816
Practice Address - Fax:541-687-1086
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11360207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR005785Medicaid
OR005785Medicaid