Provider Demographics
NPI:1043917693
Name:CASTLE PHYSICIAN NETWORK
Entity Type:Organization
Organization Name:CASTLE PHYSICIAN NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:A
Authorized Official - Last Name:DICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-263-5011
Mailing Address - Street 1:640 ULUKAHIKI ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4454
Mailing Address - Country:US
Mailing Address - Phone:808-263-5011
Mailing Address - Fax:
Practice Address - Street 1:1245 KUALA ST # 13
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3900
Practice Address - Country:US
Practice Address - Phone:808-456-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASTLE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty