Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 36886 | AZ |
N | 2080P0201X | Pediatric Allergist | 46975 | WI |
NPI | 1306898846 |
---|---|
Provider Name | Dr. Ryan Matthew Casper |
First Address | Peoria, AZ 85381-6097 |
Second Address | Peoria, AZ 85381-6097 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 01/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009906261K | HUMANA (01) | |
34552100 | (05) | WI |
I23650 | (02) | |
I23650 | (02) | AZ |