Provider Demographics
NPI:1275640252
Name:CASADA, JOHN HOUSTON (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HOUSTON
Last Name:CASADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VILLAGE DR STE 350
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-8231
Mailing Address - Country:US
Mailing Address - Phone:325-672-7055
Mailing Address - Fax:325-672-7066
Practice Address - Street 1:1 VILLAGE DR STE 350
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8231
Practice Address - Country:US
Practice Address - Phone:325-672-7055
Practice Address - Fax:325-672-7066
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK43872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX40940101Medicaid
TX260043069Medicare PIN
TX40940101Medicaid