Provider Demographics
NPI:1063400836
Name:CASAS, CARMEN CECILIA (M D)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:CECILIA
Last Name:CASAS
Suffix:
Gender:F
Credentials:M D
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF3424207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83J076OtherBLUE CROSS BLUE SHIELD
TXC14264Medicare UPIN
TX00F43EMedicare ID - Type Unspecified