Provider Demographics
NPI:1255301198
Name:CASTRO, HERACLIO F JR (MD)
Entity Type:Individual
Prefix:
First Name:HERACLIO
Middle Name:F
Last Name:CASTRO
Suffix:JR
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 1:2925 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-6459
Mailing Address - Country:US
Mailing Address - Phone:407-922-6077
Mailing Address - Fax:888-344-9692
Practice Address - Street 1:2925 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-6459
Practice Address - Country:US
Practice Address - Phone:407-922-6077
Practice Address - Fax:888-344-9692
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20548208800000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55445Medicare UPIN