Provider Demographics
NPI:1093723835
Name:CASEY, DAVID N N (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:N N
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 1:412 N 200 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4038
Mailing Address - Country:US
Mailing Address - Phone:435-713-2710
Mailing Address - Fax:435-713-2747
Practice Address - Street 1:412 N. 200 E.
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321
Practice Address - Country:US
Practice Address - Phone:435-713-2710
Practice Address - Fax:435-713-2747
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT331338-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200527880Medicaid
IN200527880Medicaid
IN048580L6Medicare ID - Type Unspecified