=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013342922
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANK P CASERTA MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2013
-----------------------------------------------------
Last Update Date | 09/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2600 S RURAL RD SUITE B
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-2448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-967-3381
-----------------------------------------------------
Fax | 480-967-0755
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2600 S. RURAL RD SUITE B
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-2448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-967-3381
-----------------------------------------------------
Fax | 480-967-0755
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. FRANK P CASERTA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 480-967-3381
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | AZ25755
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------