Healthcare Provider Details

I. General information

NPI: 1265567903
Provider Name (Legal Business Name): DONALD CASE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 S 6TH AVE
BARSTOW CA
92311-2935
US

IV. Provider business mailing address

412 S 6TH AVE
BARSTOW CA
92311-2935
US

V. Phone/Fax

Practice location:
  • Phone: 760-256-0213
  • Fax: 760-256-4073
Mailing address:
  • Phone: 760-256-0213
  • Fax: 760-256-4073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG58540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: