Provider Demographics
NPI:1972711463
Name:TABER, CASEY D (MD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:D
Last Name:TABER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:400 CONCORD PLAZA DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6905
Mailing Address - Country:US
Mailing Address - Phone:210-804-5460
Mailing Address - Fax:210-804-5461
Practice Address - Street 1:150 E SONTERRA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4184
Practice Address - Country:US
Practice Address - Phone:210-804-5460
Practice Address - Fax:210-804-5461
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM2141207X00000X
CO45669207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972711463OtherNPI
TX145160102Medicaid
00594ROtherGROUP PTAN
00594ROtherGROUP PTAN
1972711463OtherNPI