Basic Information
Provider Information | |||||||||
NPI: | 1811331663 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CASPER | ||||||||
FirstName: | CORTNEY | ||||||||
MiddleName: | B | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 829 N CENTER AVE STE 200 | ||||||||
Address2: |   | ||||||||
City: | GAYLORD | ||||||||
State: | MI | ||||||||
PostalCode: | 497351598 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9897312105 | ||||||||
FaxNumber: | 9897317929 | ||||||||
Practice Location | |||||||||
Address1: | 98 POPLAR ST | ||||||||
Address2: |   | ||||||||
City: | BLACKFOOT | ||||||||
State: | ID | ||||||||
PostalCode: | 832211758 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2087823900 | ||||||||
FaxNumber: | 2087823986 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/23/2013 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301103276 | MI | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   | 207V00000X | 2154193 | MI | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   | 207V00000X | M-14718 | ID | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
No ID Information.