Provider Demographics
NPI:1518609353
Name:ROARK, CASEY (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:ROARK
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 1:809 OXMOOR RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5233
Mailing Address - Country:US
Mailing Address - Phone:985-237-0601
Mailing Address - Fax:
Practice Address - Street 1:833 PRINCETON AVENUE SW
Practice Address - Street 2:PROFESSIONAL OFFICE BUILDING 3, SUITE 200-E
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211
Practice Address - Country:US
Practice Address - Phone:205-783-7694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program