Provider Demographics
NPI:1073735155
Name:CASTOR, DAVID RANDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RANDALL
Last Name:CASTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2029
Mailing Address - Street 2:
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-5029
Mailing Address - Country:US
Mailing Address - Phone:828-538-4546
Mailing Address - Fax:828-538-4549
Practice Address - Street 1:80 VETERAN'S BLVD
Practice Address - Street 2:
Practice Address - City:BRYSON CITY
Practice Address - State:NC
Practice Address - Zip Code:28713-4200
Practice Address - Country:US
Practice Address - Phone:828-538-4846
Practice Address - Fax:828-538-4847
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81856207Q00000X
OH57-012724207Q00000X
NC2010-0599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC818565Medicaid