Provider Demographics
NPI:1245503903
Name:CASSIDY, GEORGE F III (PA-C)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:F
Last Name:CASSIDY
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 BOND ST
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-3082
Mailing Address - Country:US
Mailing Address - Phone:210-870-9365
Mailing Address - Fax:
Practice Address - Street 1:BLDG 1014 27TH ST
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1102058363AM0700X
TXPA09724363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical