Provider Demographics
NPI:1205972049
Name:CASSAR, MARCUS JAMES (CPO)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:JAMES
Last Name:CASSAR
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-3006
Mailing Address - Country:US
Mailing Address - Phone:503-243-1974
Mailing Address - Fax:503-243-2606
Practice Address - Street 1:2824 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-3006
Practice Address - Country:US
Practice Address - Phone:503-243-1974
Practice Address - Fax:503-243-2606
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213-000222222Z00000X
IL211-000184224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist