Provider Demographics
NPI:1932325776
Name:CASSIDY, JASON P (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:P
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7239
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-0239
Mailing Address - Country:US
Mailing Address - Phone:402-489-9400
Mailing Address - Fax:
Practice Address - Street 1:7121 STEPHANIE LN
Practice Address - Street 2:STE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5359
Practice Address - Country:US
Practice Address - Phone:402-420-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04318682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099920001Medicare PIN
NE092555001Medicare PIN