1336106137 NPI number — DR. ROMEO E CASTILLO M.D.

Table of content: DR. ROMEO E CASTILLO M.D. (NPI 1336106137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336106137 NPI number — DR. ROMEO E CASTILLO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTILLO
Provider First Name:
ROMEO
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASTILLO-MELENDEZ
Provider Other First Name:
ROMEO
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1336106137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1131 NW 64TH TER
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32605-4228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-332-9940
Provider Business Mailing Address Fax Number:
352-332-9939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1131 NW 64TH TER
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32605-4228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-332-9940
Provider Business Practice Location Address Fax Number:
352-332-9939
Provider Enumeration Date:
04/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME0079357 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 268130 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 257873500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49423 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DM44934 . This is a "BEECH STREET" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7506053 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 257873500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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