Provider Demographics
NPI:1053359752
Name:SASSARD, WALTER RANDALL (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:RANDALL
Last Name:SASSARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:2727 W HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1669
Practice Address - Country:US
Practice Address - Phone:713-442-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3103207XS0117X, 208100000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200021957OtherMEDICARE RAILROAD
TX4300016OtherAETNA US HEALTHCARE
TX741660214OtherHEALTH NEW ENGLAND
TX8FE522OtherBLUE CROSS BLUE SHIELD
OH741660214-00OtherOHIO BWC
TX8431NWMedicaid
TX132013707Medicaid
TX843089OtherBCBS OF TEXAS
TX132013710Medicaid
TX1320137-06Medicaid
TX1571290OtherCIGNA
NY741660214OtherWORKERS' COMP NY
TX1320137-06Medicaid
TX436155YUD8Medicare PIN
TX436155YMVQMedicare PIN
TX843089OtherBCBS OF TEXAS
TX132013707Medicaid