Provider Demographics
NPI:1083600050
Name:CASTRO, ROBERTO PEPE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:PEPE
Last Name:CASTRO
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 1:23019 HIGHWAY 149
Mailing Address - Street 2:
Mailing Address - City:SIGOURNEY
Mailing Address - State:IA
Mailing Address - Zip Code:52591-8341
Mailing Address - Country:US
Mailing Address - Phone:641-622-2720
Mailing Address - Fax:641-622-1187
Practice Address - Street 1:23019 HIGHWAY 149
Practice Address - Street 2:
Practice Address - City:SIGOURNEY
Practice Address - State:IA
Practice Address - Zip Code:52591-8341
Practice Address - Country:US
Practice Address - Phone:641-622-2720
Practice Address - Fax:641-622-1187
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094399207P00000X, 207R00000X
IA39883207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619414OtherBCBS GROUP
IL036094399Medicaid
IL3633309286030501Medicaid
IL01626571OtherBLUE CROSS & BLUE SHIELD
ILK53671 EP&DP ICCMedicare PIN
IL3633309286030501Medicaid
IL01626571OtherBLUE CROSS & BLUE SHIELD
IL1619414OtherBCBS GROUP