Healthcare Provider Details

I. General information

NPI: 1992779425
Provider Name (Legal Business Name): BRENDAN P CASSIDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 10/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 N 7TH ST SUITE 100
PHOENIX AZ
85006-2754
US

IV. Provider business mailing address

PO BOX 97876
PHOENIX AZ
85060-7876
US

V. Phone/Fax

Practice location:
  • Phone: 602-222-2234
  • Fax: 602-222-3025
Mailing address:
  • Phone: 602-222-2234
  • Fax: 602-222-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number22365
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: