Basic Information
| Provider Information | |||||||||
| NPI: | 1588636252 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASNER | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | DAMION | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40232 JUNCTION DR | ||||||||
| Address2: | |||||||||
| City: | OAKHURST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596586420 | ||||||||
| FaxNumber: | 5596586460 | ||||||||
| Practice Location | |||||||||
| Address1: | 40232 JUNCTION DR | ||||||||
| Address2: | |||||||||
| City: | OAKHURST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596586420 | ||||||||
| FaxNumber: | 5596586460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G76569 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00F765690 | 05 | CA | MEDICAID |