Provider Demographics
NPI:1225270309
Name:EDMUND CASPER MD PC
Entity Type:Organization
Organization Name:EDMUND CASPER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:
Authorized Official - Last Name:CASPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-755-4271
Mailing Address - Street 1:1879 S XENIA CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3331
Mailing Address - Country:US
Mailing Address - Phone:303-755-4271
Mailing Address - Fax:303-337-2897
Practice Address - Street 1:3400 E BAYAUD AVE
Practice Address - Street 2:STE:210
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2926
Practice Address - Country:US
Practice Address - Phone:303-880-3545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16856103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty