Provider Demographics
NPI:1477669471
Name:CURTIS W CASSIDY M D P A
Entity Type:Organization
Organization Name:CURTIS W CASSIDY M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-686-0800
Mailing Address - Street 1:832 S FLORIDA AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5202
Mailing Address - Country:US
Mailing Address - Phone:863-686-0800
Mailing Address - Fax:863-686-0805
Practice Address - Street 1:832 S FLORIDA AVE STE 2
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5202
Practice Address - Country:US
Practice Address - Phone:863-686-0800
Practice Address - Fax:863-686-0805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME861032084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Multi-Specialty