Provider Demographics
NPI:1750484358
Name:RASBERRY - CASSELBERRY, BRENDA L (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:L
Last Name:RASBERRY - CASSELBERRY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:L
Other - Last Name:CASSELBERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:P O BOX 1268
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36831
Mailing Address - Country:US
Mailing Address - Phone:334-705-0544
Mailing Address - Fax:334-705-0548
Practice Address - Street 1:2121 EXECUTIVE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801
Practice Address - Country:US
Practice Address - Phone:334-705-0544
Practice Address - Fax:334-705-0548
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL132213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL480013769OtherMEDICARE RAILROAD
AL51540360OtherBCBS - TUSKEGEE
AL529912550Medicaid
AL51540725OtherBCBS - OPELIKA
AL5043300001OtherPALMETTO DMERC PROVIDER
ALCM3112OtherMEDICARE R/R PIN
AL51540360OtherBCBS - TUSKEGEE
AL480013769OtherMEDICARE RAILROAD
AL631072881OtherEIN