Provider Demographics
NPI:1992998959
Name:CARMEN CASAS, MD, PA
Entity type:Organization
Organization Name:CARMEN CASAS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CASAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-994-1001
Mailing Address - Street 1:5756 S STAPLES ST
Mailing Address - Street 2:STE J1
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3782
Mailing Address - Country:US
Mailing Address - Phone:361-994-1001
Mailing Address - Fax:361-994-1004
Practice Address - Street 1:5756 S STAPLES ST
Practice Address - Street 2:STE J1
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3782
Practice Address - Country:US
Practice Address - Phone:361-994-1001
Practice Address - Fax:361-994-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3424207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00F43EOtherMEDICARE ID-TYPE UNSPECIF
TX83J076OtherBLUE CROSS BLUE SHIELD
TX83J076OtherBLUE CROSS BLUE SHIELD