Provider Demographics
NPI:1265206239
Name:CASIMIR, THIERRY (PA)
Entity type:Individual
Prefix:
First Name:THIERRY
Middle Name:
Last Name:CASIMIR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 FALLIN BLVD APT C2
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4368
Mailing Address - Country:US
Mailing Address - Phone:919-440-6347
Mailing Address - Fax:
Practice Address - Street 1:1865 N HIGLEY RD APT 2005
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-3333
Practice Address - Country:US
Practice Address - Phone:919-440-6347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant