Provider Demographics
NPI:1306898846
Name:CASPER, RYAN MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MATTHEW
Last Name:CASPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13965 N. 75TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-6097
Mailing Address - Country:US
Mailing Address - Phone:602-843-2991
Mailing Address - Fax:602-978-1226
Practice Address - Street 1:13965 N. 75TH AVENUE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-6097
Practice Address - Country:US
Practice Address - Phone:602-843-2991
Practice Address - Fax:602-978-1226
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI469752080P0201X
AZ36886207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
009906261KOtherHUMANA
WI34552100Medicaid
WI34552100Medicaid
009906261KOtherHUMANA