Provider Demographics
NPI:1689671638
Name:FASSIO, JOHN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:FASSIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2700 HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-4857
Mailing Address - Country:US
Mailing Address - Phone:435-615-0435
Mailing Address - Fax:435-658-3094
Practice Address - Street 1:2700 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-4857
Practice Address - Country:US
Practice Address - Phone:435-658-3090
Practice Address - Fax:435-658-3094
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6778A207W00000X
UT262669-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F70909Medicare UPIN
UT005723701Medicare ID - Type UnspecifiedHEBER CITY
WYW9569Medicare PIN