Healthcare Provider Details

I. General information

NPI: 1477794428
Provider Name (Legal Business Name): PAMELA W. CASSON, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 KELLY JOHNSON BLVD SUITE 220
COLORADO SPRINGS CO
80920-3955
US

IV. Provider business mailing address

5605 COACHWOOD TRL
COLORADO SPRINGS CO
80919-4454
US

V. Phone/Fax

Practice location:
  • Phone: 719-265-1050
  • Fax: 719-265-2503
Mailing address:
  • Phone: 719-598-0631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAMELA WALLACE CASSON
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 719-598-0631