Healthcare Provider Details

I. General information

NPI: 1659728855
Provider Name (Legal Business Name): CASEY MRAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 N LOOP 250 W BLDG 4
MIDLAND TX
79707-6034
US

IV. Provider business mailing address

4214 ANDREWS HWY STE 240
MIDLAND TX
79703-4817
US

V. Phone/Fax

Practice location:
  • Phone: 432-221-3300
  • Fax:
Mailing address:
  • Phone: 432-686-6605
  • Fax: 432-682-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS0748
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: