Healthcare Provider Details

I. General information

NPI: 1811956717
Provider Name (Legal Business Name): CHRISTOPHER J CASEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W INDIAN AVE
BREWSTER WA
98812
US

IV. Provider business mailing address

PO BOX 337
BREWSTER WA
98812-0337
US

V. Phone/Fax

Practice location:
  • Phone: 509-689-2525
  • Fax: 509-689-3247
Mailing address:
  • Phone: 509-689-2525
  • Fax: 509-689-3247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10004353
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: