MEDICARE: JOHN S CASKEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD20060456	NM
2	208M00000X	Hospitalist Physician	MD2006-0456	NM
3	208VP0000X	Pain Medicine Physician	MD2006-0456	NM

General Provider Information

NPI Number	:	1417061391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN S CASKEY MD

Provider Business Mailing Address
First Line	:	1421 LUISA ST STE I
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4073
Country	:	US
Telephone Number	:	505-982-8338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 LUISA ST
Second Line	:	UNIT I
City	:	SANTA FE
State	:	NM
Zip	:	87505-4073
Country	:	US
Telephone Number	:	505-982-8338
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	04/02/2012

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Directions to “ JOHN S CASKEY MD” Practice Location

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