Provider Demographics
NPI:1417307505
Name:CASSMEYER, KENT ALEXANDER NEIL (MD)
Entity Type:Individual
Prefix:
First Name:KENT ALEXANDER
Middle Name:NEIL
Last Name:CASSMEYER
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 1:300 WINDING WOODS DR STE 214
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4773
Mailing Address - Country:US
Mailing Address - Phone:636-614-3289
Mailing Address - Fax:636-272-3680
Practice Address - Street 1:300 WINDING WOODS DR STE 214
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4773
Practice Address - Country:US
Practice Address - Phone:636-614-3289
Practice Address - Fax:636-272-3680
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019024541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine