Healthcare Provider Details

I. General information

NPI: 1740248319
Provider Name (Legal Business Name): EDMUND CASPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 E BAYAUD AVE 210
DENVER CO
80209-2926
US

IV. Provider business mailing address

1879 S XENIA CT
DENVER CO
80231-3331
US

V. Phone/Fax

Practice location:
  • Phone: 303-880-3545
  • Fax:
Mailing address:
  • Phone: 303-755-4271
  • Fax: 303-337-2897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number16856
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: