Provider Demographics
NPI:1164425914
Name:CASKEY, PATRICK J (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:CASKEY
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 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 380
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3612
Mailing Address - Country:US
Mailing Address - Phone:707-575-5353
Mailing Address - Fax:707-523-7729
Practice Address - Street 1:3536 MENDOCINO AVE
Practice Address - Street 2:STE 380
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3612
Practice Address - Country:US
Practice Address - Phone:707-575-5353
Practice Address - Fax:707-523-7729
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2008-06-23
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
CAG048761207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G4876100Medicaid
CA180006567OtherMEDICARE RAILROAD
CA00G4876100Medicaid
CA180006567OtherMEDICARE RAILROAD