Healthcare Provider Details

I. General information

NPI: 1881698256
Provider Name (Legal Business Name): CASEY L HUSTON MD PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 N 91ST ST STE A115
SCOTTSDALE AZ
85258-5036
US

IV. Provider business mailing address

6422 E CAROLINA DR
SCOTTSDALE AZ
85254-2004
US

V. Phone/Fax

Practice location:
  • Phone: 602-680-7730
  • Fax: 602-680-7095
Mailing address:
  • Phone: 602-680-7730
  • Fax: 602-680-7095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number19593
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: