Healthcare Provider Details

I. General information

NPI: 1487604260
Provider Name (Legal Business Name): GREGORY D CASEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/07/2023
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 ESTATE DIAMOND RUBY
ST CROIX VI
00820-4435
US

IV. Provider business mailing address

PO BOX 5975
CHRISTIANSTED VI
00823-5975
US

V. Phone/Fax

Practice location:
  • Phone: 340-778-6311
  • Fax:
Mailing address:
  • Phone: 517-937-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number3035
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number4301050406
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number3035
License Number StateVI
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number3035
License Number StateVI
# 5
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number4301050406
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: