Provider Demographics
NPI:1922088277
Name:CASEY, TERRI J (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:J
Last Name:CASEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8255
Mailing Address - Fax:972-383-2839
Practice Address - Street 1:403 W CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3465
Practice Address - Country:US
Practice Address - Phone:972-498-4742
Practice Address - Fax:972-498-4836
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6366207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00408127OtherRR MEDICARE
TX042646204Medicaid
TX042646202Medicaid
TXP00408127OtherRR MEDICARE
TXG69652Medicare UPIN
TX8C1547Medicare ID - Type Unspecified
TX042646202Medicaid