Provider Demographics
NPI:1235112517
Name:DEACON-CASEY, MEGAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:E
Last Name:DEACON-CASEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 A1A N STE 321
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1826
Mailing Address - Country:US
Mailing Address - Phone:904-280-0600
Mailing Address - Fax:904-280-0601
Practice Address - Street 1:330 A1A N
Practice Address - Street 2:SUITE 322
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1823
Practice Address - Country:US
Practice Address - Phone:904-551-0703
Practice Address - Fax:904-551-0709
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME888392085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280670300Medicaid
FL280670300Medicaid
FLI04150Medicare UPIN