Basic Information
| Provider Information | |||||||||
| NPI: | 1629030648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHASSAY | ||||||||
| FirstName: | DEAN | ||||||||
| MiddleName: | RANDALL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1547 | ||||||||
| Address2: | |||||||||
| City: | SEDALIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 653021547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608265960 | ||||||||
| FaxNumber: | 6608264852 | ||||||||
| Practice Location | |||||||||
| Address1: | 8000 AL HIGHWAY 69 | ||||||||
| Address2: | MARSHALL MEDICAL CENTER NORTH | ||||||||
| City: | GUNTERSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359767140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565718000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 10/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 24930 | AL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 24930 | AL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 051534597 | 01 | AL | BCBS | OTHER | P00329806 | 01 | AL | RR MEDICARE | OTHER | 009937733 | 05 | AL | MEDICAID |