Provider Demographics
NPI:1518924141
Name:CASTER, PHILIP W (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:W
Last Name:CASTER
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 1:212 COACH RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-4204
Mailing Address - Country:US
Mailing Address - Phone:417-532-1258
Mailing Address - Fax:
Practice Address - Street 1:732 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-3591
Practice Address - Country:US
Practice Address - Phone:417-532-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO31878MD207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0103801OtherUNITED HEALTHCARE
MO171389OtherHEALTHLINK
MO200434223Medicaid
MO3249OtherCOX-FREEMAN
MO7364OtherBCBS
MO200434223Medicaid
MO7364OtherBCBS
MOA27461Medicare UPIN