Healthcare Provider Details

I. General information

NPI: 1306587399
Provider Name (Legal Business Name): CASEY TAYLOR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 PINION DR
USAF ACADEMY CO
80840-2502
US

IV. Provider business mailing address

4102 PINION DR
USAF ACADEMY CO
80840-2502
US

V. Phone/Fax

Practice location:
  • Phone: 385-227-4496
  • Fax:
Mailing address:
  • Phone: 385-227-4496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0077505
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: