Provider Demographics
NPI:1336106137
Name:CASTILLO, ROMEO E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMEO
Middle Name:E
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROMEO
Other - Middle Name:E
Other - Last Name:CASTILLO-MELENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1131 NW 64TH TER
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4228
Mailing Address - Country:US
Mailing Address - Phone:352-332-9940
Mailing Address - Fax:352-332-9939
Practice Address - Street 1:1131 NW 64TH TER
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4228
Practice Address - Country:US
Practice Address - Phone:352-332-9940
Practice Address - Fax:352-332-9939
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0079357208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268130OtherAVMED
FL257873500Medicaid
FL49423OtherBCBS
FLDM44934OtherBEECH STREET
7506053OtherAETNA
FL49423OtherBCBS