Provider Demographics
NPI:1003974783
Name:MORALES DEL CASTILLO, OSVALDO R (M D)
Entity Type:Individual
Prefix:DR
First Name:OSVALDO
Middle Name:R
Last Name:MORALES DEL CASTILLO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4048 EVANS AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901
Mailing Address - Country:US
Mailing Address - Phone:239-278-9983
Mailing Address - Fax:239-278-9985
Practice Address - Street 1:4048 EVANS AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901
Practice Address - Country:US
Practice Address - Phone:239-278-9983
Practice Address - Fax:239-278-9985
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME57921208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063212100Medicaid
F25118Medicare UPIN