Provider Demographics
NPI:1053449983
Name:CASEY L HUSTON MD PC
Entity type:Organization
Organization Name:CASEY L HUSTON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-680-7730
Mailing Address - Street 1:4045 E BELL RD
Mailing Address - Street 2:STE 127
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2236
Mailing Address - Country:US
Mailing Address - Phone:602-680-7730
Mailing Address - Fax:602-680-7095
Practice Address - Street 1:4045 E BELL RD
Practice Address - Street 2:STE 127
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2236
Practice Address - Country:US
Practice Address - Phone:602-680-7730
Practice Address - Fax:602-680-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ113459Medicare PIN