Provider Demographics
NPI:1992321566
Name:JOHNSON, CASEY DANIEL EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:DANIEL EDWARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 2009B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8265
Mailing Address - Country:US
Mailing Address - Phone:314-251-6062
Mailing Address - Fax:314-251-4376
Practice Address - Street 1:1900 S TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3114
Practice Address - Country:US
Practice Address - Phone:941-330-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS21187207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty