Provider Demographics
NPI:1194782524
Name:CASEY, ALICE ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:ELAINE
Last Name:CASEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:152 PIONEER LN
Mailing Address - Street 2:SUITE H
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2563
Mailing Address - Country:US
Mailing Address - Phone:760-873-6373
Mailing Address - Fax:760-873-3266
Practice Address - Street 1:152 PIONEER LN
Practice Address - Street 2:SUITE H
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2563
Practice Address - Country:US
Practice Address - Phone:760-873-6373
Practice Address - Fax:760-873-3266
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG25251208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G252510Medicaid
CAA42590Medicare UPIN