Provider Demographics
NPI:1225106388
Name:CASTANEDA, ROGELIO (MD)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROGELIO
Other - Middle Name:
Other - Last Name:CASTANEDA-TEJEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6215 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-5007
Mailing Address - Country:US
Mailing Address - Phone:469-868-6322
Mailing Address - Fax:
Practice Address - Street 1:6215 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-5007
Practice Address - Country:US
Practice Address - Phone:469-868-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70563207P00000X, 207R00000X
TXL1540207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM88725731Medicaid
TX158843618Medicaid
TXP00831062OtherRAILROAD
TXP00831062OtherRAILROAD