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General NPI Number Information
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NPI Number | 1164505483
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Entity Type | Individual
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Provider Name | JACK L CASSELL MD
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 717 NORTH DONNELLY STREET
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City | MOUNT DORA
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State | FL
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Zip | 32757
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Country | US
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Telephone | 352-383-3773
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Fax | 352-383-4434
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Provider Business Mailing Address
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Address Line | 717 NORTH DONNELLY STREET
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City | MOUNT DORA
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State | FL
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Zip | 32757
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Country | US
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Telephone | 352-383-3773
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Fax | 352-383-4434
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME46095
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | ME46095
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME46095
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License Number State | FL
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