Provider Demographics
NPI:1669135729
Name:MEYERING, CASEY
Entity type:Individual
Prefix:MR
First Name:CASEY
Middle Name:
Last Name:MEYERING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 ANTIGUA DR
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-2109
Mailing Address - Country:US
Mailing Address - Phone:707-704-0227
Mailing Address - Fax:
Practice Address - Street 1:603 ANTIGUA DR
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-2109
Practice Address - Country:US
Practice Address - Phone:707-704-0227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date: