Provider Demographics
NPI:1205839057
Name:CASTLE, JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:CASTLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 NE 7TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1430
Mailing Address - Country:US
Mailing Address - Phone:541-471-3668
Mailing Address - Fax:541-471-4814
Practice Address - Street 1:1227 NE 7TH ST
Practice Address - Street 2:STE A
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1430
Practice Address - Country:US
Practice Address - Phone:541-471-3668
Practice Address - Fax:541-471-4814
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00246213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR118716Medicaid
OR0000SGBLKMedicare ID - Type Unspecified
ORU35695Medicare UPIN