Provider Demographics
NPI:1518063809
Name:CASADY, WILLIAM S (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:CASADY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63565-0284
Mailing Address - Country:US
Mailing Address - Phone:660-947-2425
Mailing Address - Fax:
Practice Address - Street 1:1926 OAK ST
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:MO
Practice Address - Zip Code:63565-1180
Practice Address - Country:US
Practice Address - Phone:660-947-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7B26207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241574128Medicaid
IA1918417Medicaid
IA1918417Medicaid
MO241574128Medicaid