Provider Demographics
NPI:1235384017
Name:CHAN, JOSEPH EDWARD CASTILLO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH EDWARD
Middle Name:CASTILLO
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:8421 POINTE LOOP DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-2232
Practice Address - Country:US
Practice Address - Phone:941-681-8500
Practice Address - Fax:941-681-8501
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME116702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009056200Medicaid
FL009056200Medicaid