Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 0101029301 | VA |
N | 207P00000X | Emergency Physician | 28215 | WV |
N | 207PE0004X | Emergency Medical Services | 2006028599 | MO |
NPI | 1164459657 |
---|---|
Provider Name | Dr. Casey John Jason |
First Address | Saint Joseph, MO 64505-3717 |
Second Address | Saint Joseph, MO 64506-3488 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 06/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1164459657 | (05) | VA |
1164459657 | (05) | WV |
D19162 | (02) | VA |