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General NPI Number Information
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NPI Number | 1174808794
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Entity Type | Organization
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Legal Business Name | HOLLY D. CASEY, MD. A PROFESSIONAL MEDICAL CORP.
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 8600 FERN AVENUE
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City | SHREVEPORT
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State | LA
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Zip | 71105
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Country | US
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Telephone | 318-795-0801
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Fax | 318-795-9492
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Provider Business Mailing Address
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Address Line | 8600 FERN AVENUE
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City | SHREVEPORT
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State | LA
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Zip | 71105
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Country | US
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Telephone | 318-795-0801
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Fax | 318-795-9492
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOLLY D. CASEY
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Credential | M.D.
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Telephone | 318-795-0801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | L14095R
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License Number State | LA
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