Provider Demographics
NPI:1407808785
Name:CASE, EDWARD P (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:P
Last Name:CASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:530 LILLY RD SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2105
Mailing Address - Country:US
Mailing Address - Phone:360-915-3222
Mailing Address - Fax:360-491-4947
Practice Address - Street 1:3102 EAST HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PATTON
Practice Address - State:CA
Practice Address - Zip Code:92369
Practice Address - Country:US
Practice Address - Phone:909-425-7000
Practice Address - Fax:909-425-7520
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000471112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OOA674410Medicare ID - Type Unspecified
H69430Medicare UPIN