Provider Demographics
NPI:1023035623
Name:CASTILLO, EDUARDO D (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:D
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-924-9960
Practice Address - Street 1:2000 COOPER ST STE 100B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2528
Practice Address - Country:US
Practice Address - Phone:817-924-9002
Practice Address - Fax:817-924-9960
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1568208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173827001Medicaid
P00234425OtherRAILROAD MEDICARE