Healthcare Provider Details

I. General information

NPI: 1164403937
Provider Name (Legal Business Name): SCOTT A CASSIDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83825 HIGHWAY 9
ASHLAND AL
36251-7981
US

IV. Provider business mailing address

83825 HIGHWAY 9
ASHLAND AL
36251-7981
US

V. Phone/Fax

Practice location:
  • Phone: 256-496-2576
  • Fax: 256-354-1129
Mailing address:
  • Phone: 256-496-2576
  • Fax: 256-354-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036136916
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number00025351
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number62414
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25351
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: