Healthcare Provider Details

I. General information

NPI: 1407174626
Provider Name (Legal Business Name): CASSANDRA STEIN NOSSER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 CLINIC DR
DOTHAN AL
36303-1980
US

IV. Provider business mailing address

4370 WEST MAIN STREET
DOTHAN AL
36305-1056
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-1881
  • Fax:
Mailing address:
  • Phone: 334-793-5000
  • Fax: 334-615-8418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26438
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31437
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier103797000
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: