Provider Demographics
NPI:1679653976
Name:CASSADY, JOSEPH WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WAYNE
Last Name:CASSADY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6463 GRIFFITH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901
Mailing Address - Country:US
Mailing Address - Phone:530-749-8313
Mailing Address - Fax:530-749-6281
Practice Address - Street 1:5730 PACKARD AVENUE
Practice Address - Street 2:SUITE 500
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901
Practice Address - Country:US
Practice Address - Phone:530-749-8313
Practice Address - Fax:530-749-6281
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5572207QA0401X, 208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABC0863781OtherDEA
CABC0863781OtherDEA