Provider Demographics
NPI:1386686541
Name:WEST, CASEY S (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:S
Last Name:WEST
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 1:5217 OLD SPICEWOOD SPRINGS RD
Mailing Address - Street 2:#2212
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1036
Mailing Address - Country:US
Mailing Address - Phone:512-708-8654
Mailing Address - Fax:
Practice Address - Street 1:12221 NORTH MOPAC
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TN
Practice Address - Zip Code:78758
Practice Address - Country:US
Practice Address - Phone:512-901-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4170207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153291304Medicaid
TX153291305Medicaid
TX8D2194Medicare ID - Type Unspecified
TX153291304Medicaid
TX8D2018Medicare ID - Type Unspecified