Provider Demographics
NPI:1083012280
Name:CASEY, GREGORY PATRICK (LMT)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PATRICK
Last Name:CASEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 N HULLEN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-6915
Mailing Address - Country:US
Mailing Address - Phone:504-432-9844
Mailing Address - Fax:504-432-9844
Practice Address - Street 1:2325 N HULLEN ST STE 101
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-6915
Practice Address - Country:US
Practice Address - Phone:504-432-9844
Practice Address - Fax:504-432-9844
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-21
Last Update Date:2014-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5729174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist