Provider Demographics
NPI:1114153103
Name:CAMACHO, ALLAN CASTILLO (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:CASTILLO
Last Name:CAMACHO
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 1:1313 BROADWAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-3277
Mailing Address - Country:US
Mailing Address - Phone:806-765-2611
Mailing Address - Fax:806-765-2604
Practice Address - Street 1:5424 19TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2162
Practice Address - Country:US
Practice Address - Phone:806-722-4453
Practice Address - Fax:806-722-4461
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2012-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXP3297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine