Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 14870 | TX |
NPI | 1700557048 |
---|---|
Provider Name | Dr. Jaston Shields Casey |
First Address | Boyd, TX 76023-3118 |
Second Address | Boyd, TX 76023-3118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2021 |
Last Update Date | 27/09/2021 |