Provider Demographics
NPI:1073506341
Name:CASTILLO, RAUL C (MD)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:C
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 1:894 E ALTAMONTE DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5002
Mailing Address - Country:US
Mailing Address - Phone:407-834-5151
Mailing Address - Fax:407-896-1926
Practice Address - Street 1:894 E ALTAMONTE DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5002
Practice Address - Country:US
Practice Address - Phone:407-834-5151
Practice Address - Fax:407-896-1926
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61838207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374932100Medicaid
FL14917YMedicare ID - Type Unspecified
FL374932100Medicaid