Provider Demographics
NPI:1346252152
Name:LAW, CASEY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:SCOTT
Last Name:LAW
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 1:2500 NE NEFF RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:51781 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-1118
Practice Address - Country:US
Practice Address - Phone:541-666-7920
Practice Address - Fax:541-666-7919
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7111834-1205207Q00000X
WAMD 00049004207Q00000X
ORMD202900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2015110Medicaid
WAG8904768Medicare PIN