Provider Demographics
NPI:1275642191
Name:CASPER, JOHN B (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:CASPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:272 E 36TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83714-6523
Mailing Address - Country:US
Mailing Address - Phone:208-514-0518
Mailing Address - Fax:208-486-4009
Practice Address - Street 1:272 E 36TH ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-6523
Practice Address - Country:US
Practice Address - Phone:208-514-0518
Practice Address - Fax:208-486-4009
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM4860207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC92369Medicare UPIN