Provider Demographics
NPI:1295783157
Name:CASSELS, JOHN W JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:CASSELS
Suffix:JR
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 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:500 KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8104
Practice Address - Country:US
Practice Address - Phone:573-499-6071
Practice Address - Fax:573-499-6065
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8P60207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12172OtherBLUE CHOICE
MO2086352401OtherKANSAS MEDICAID
MO165425OtherHEALTHLINK
MO7409031OtherUNITED HEALTHCARE
MO12172OtherBLUE SHIELD
MO203185103Medicaid
MO12172OtherBLUE CHOICE
MO968215236Medicare PIN
MO203185103Medicaid
MOP00678413Medicare PIN
MO403010635Medicare PIN