Healthcare Provider Details

I. General information

NPI: 1558359729
Provider Name (Legal Business Name): LUKE CASIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 E 3RD AVE STE 1
DURANGO CO
81301-5049
US

IV. Provider business mailing address

185 SUTTLE ST
DURANGO CO
81303-8276
US

V. Phone/Fax

Practice location:
  • Phone: 970-335-2288
  • Fax: 970-335-2280
Mailing address:
  • Phone: 970-335-2232
  • Fax: 970-335-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42099
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: