Basic Information
| Provider Information | |||||||||
| NPI: | 1174570998 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASKEY | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | BRIAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10338 EVANGELINE OAKS CIRCLE | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187971695 | ||||||||
| FaxNumber: | 3187971695 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE ST MARY PLACE | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186814500 | ||||||||
| FaxNumber: | 3186814177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 01/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 018922 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1910279 | 05 | LA | MEDICAID |