Provider Demographics
NPI:1861834608
Name:CASAUBON, JESSE T (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:T
Last Name:CASAUBON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-3909
Mailing Address - Fax:
Practice Address - Street 1:100 WASON AVE STE 340
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1179
Practice Address - Country:US
Practice Address - Phone:413-794-5265
Practice Address - Fax:413-794-1794
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2816012086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology