Provider Demographics
NPI:1144248295
Name:VASSAR, JOHN S (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:VASSAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-622-2857
Mailing Address - Fax:605-622-2852
Practice Address - Street 1:305 S STATE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4527
Practice Address - Country:US
Practice Address - Phone:605-622-5000
Practice Address - Fax:605-622-5127
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5857207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4992811OtherBLUE CROSS
ND13389Medicaid
ND25444OtherBLUE CROSS OF ND
SD55342OtherSANFORD
SD6663110511600OtherPREFERRED ONE
SD5857OtherDAKOTACARE
MT0097002Medicaid
MT0097002Medicaid
ND25444OtherBLUE CROSS OF ND
SD6663110511600OtherPREFERRED ONE
SD1144248295Medicare NSC