Healthcare Provider Details

I. General information

NPI: 1730297847
Provider Name (Legal Business Name): JAMES CHARLES CASSELL JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402
APO AE
09180-0001
US

IV. Provider business mailing address

CMR 402 BOX 2220
APO AE
09180-0023
US

V. Phone/Fax

Practice location:
  • Phone: 314-486-8754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19679
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2116
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: