Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E5622 | CA |
NPI | 1093229650 |
---|---|
Provider Name | Mr. Casey B Fillerup |
First Address | Santa Maria, CA 93455-5150 |
Second Address | Santa Maria, CA 93455-5150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2017 |
Last Update Date | 23/07/2021 |