Provider Demographics
NPI:1871722132
Name:BARRY PAUL KASSELS M D INC
Entity type:Organization
Organization Name:BARRY PAUL KASSELS M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KASSELS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:209-484-4368
Mailing Address - Street 1:9600 SW NIMBUS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7389
Mailing Address - Country:US
Mailing Address - Phone:503-372-2740
Mailing Address - Fax:
Practice Address - Street 1:1700 COFFEE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2803
Practice Address - Country:US
Practice Address - Phone:503-372-2740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78198207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG781981Medicaid
CAG25329Medicare UPIN
CAOOG781980Medicare PIN