Provider Demographics
NPI:1932136512
Name:HUNTSMAN, CASEY I (MD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:I
Last Name:HUNTSMAN
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 1:3300 WASHINGTON PARKWAY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7592
Mailing Address - Country:US
Mailing Address - Phone:208-522-6662
Mailing Address - Fax:208-522-0880
Practice Address - Street 1:3300 WASHINGTON PARKWAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7592
Practice Address - Country:US
Practice Address - Phone:208-522-6662
Practice Address - Fax:208-522-0880
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8232207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010033201OtherMEDIVANTAGE BS
ID43166OtherBLUE CROSS OF IDAHO
WA0167194OtherWASHINGTON DOL
UT264199OtherALTIUS
ID0000100033201OtherBLUE SHIELD OF IDAHO
ID0543918OtherCONSULTEC INCD
ID76929OtherBLUE CROSS OF IDAHO
MN028X3HUOtherBLUE CROSS OF MINNESOTA
UT264199OtherALTIUS
WA0167194OtherWASHINGTON DOL
ID4181050001Medicare NSC