Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 01915800 | IL |
Y | 213EG0000X | General Practice | 01915800 | IL |
NPI | 1003023383 |
---|---|
Provider Name | Dr. John Marshall Casper |
First Address | Anna, IL 62906-0489 |
Second Address | Anna, IL 62906-0489 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 08/07/2007 |