Provider Demographics
NPI:1366404626
Name:CASEY, RICK D (DO)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:D
Last Name:CASEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64744-2021
Mailing Address - Country:US
Mailing Address - Phone:417-876-2345
Mailing Address - Fax:
Practice Address - Street 1:309 E HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:EL DORADO SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64744-2021
Practice Address - Country:US
Practice Address - Phone:417-876-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2D19207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241846401Medicaid
MO033013230Medicare ID - Type UnspecifiedMO MDCR #
MO241846401Medicaid