Basic Information
| Provider Information | |||||||||
| NPI: | 1558359729 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASIAS | ||||||||
| FirstName: | LUKE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 SUTTLE ST | ||||||||
| Address2: | |||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813038276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703352232 | ||||||||
| FaxNumber: | 9703352438 | ||||||||
| Practice Location | |||||||||
| Address1: | 1970 E 3RD AVE STE 1 | ||||||||
| Address2: | |||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813015049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703352288 | ||||||||
| FaxNumber: | 9703352280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 05/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 42099 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 11288256 | 01 | NEW MEXICO MEDICAID | OTHER | 840706945162 | 01 | CO | ROCKY MOUNTAIN HEALTH PLA | OTHER | P00231961 | 01 | TRAVELERS MEDICARE | OTHER | 201047689 | 01 | PRESBYTERIAN HEALTH PLAN | OTHER | 11104341 | 05 | CO | MEDICAID | CA669196 | 01 | CO | ANTHEM BCBS | OTHER |