Basic Information
| Provider Information | |||||||||
| NPI: | 1942232038 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GASSO | ||||||||
| FirstName: | JULIUS | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 N STATE OF FRANKLIN RD | ||||||||
| Address2: | STE 2 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376043645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239264468 | ||||||||
| FaxNumber: | 4239284838 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 N STATE OF FRANKLIN RD | ||||||||
| Address2: | STE 2 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376043645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239264468 | ||||||||
| FaxNumber: | 4239284838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 04/04/2017 | ||||||||
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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 | 207RC0000X | ME0050712 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | ME50712 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | 54676 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 54676 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 04672 | 01 | FL | BLUE CROSS BLUE SHIELD NU | OTHER | 062487000 | 05 | FL | MEDICAID |