Provider Demographics
NPI:1063444099
Name:CASEY, DONALD WAYNE (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:WAYNE
Last Name:CASEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-0457
Mailing Address - Country:US
Mailing Address - Phone:256-236-9400
Mailing Address - Fax:256-238-1498
Practice Address - Street 1:700 QUINTARD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-5758
Practice Address - Country:US
Practice Address - Phone:256-236-9400
Practice Address - Fax:256-238-1498
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD32738Medicare UPIN