Individual
JOHN R GASSNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1789 SHAWANO AVE, GREEN BAY, WI 54303
(920) 499-1428
(920) 499-5808
Mailing address
PO BOX 3006, GREEN BAY, WI 54303
(920) 499-1428
(920) 499-5808
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
28941020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1018745002
UNITED HEALTHCARE MEDICAI
—
01
—
1018745003
UNITED HEALTHCARE MEDICAI
—
01
—
14404
DEAN HEALTH
—
01
—
300020918
RAILROAD MEDICARE
—
05
—
31496900
—
WI
01
—
4723988
MICHIGAN MEDICAID
MI
01
—
4767178
MICHIGAN MEDICAID
MI
01
—
567565
DEAN HEALTH
—
Enumeration date
06/20/2006
Last updated
10/08/2009
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