Provider Demographics
NPI:1992779425
Name:CASSIDY, BRENDAN P (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:P
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 97876
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-7876
Mailing Address - Country:US
Mailing Address - Phone:602-222-2234
Mailing Address - Fax:602-222-3025
Practice Address - Street 1:1331 N 7TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2754
Practice Address - Country:US
Practice Address - Phone:602-222-2234
Practice Address - Fax:602-222-3025
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ22365207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ167074Medicaid
AZ167074Medicaid
71906Medicare ID - Type Unspecified