Provider Demographics
NPI:1104015932
Name:DE CASTRO, RAYMOND M (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:M
Last Name:DE 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 1:341 W MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-2205
Mailing Address - Country:US
Mailing Address - Phone:863-241-0274
Mailing Address - Fax:808-433-8689
Practice Address - Street 1:135 E MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-2312
Practice Address - Country:US
Practice Address - Phone:386-241-0274
Practice Address - Fax:386-241-0275
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16737261QP2300X
MDD00265282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care