Provider Demographics
NPI:1356320816
Name:CASTRO, RONALD JOSEPH SR (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JOSEPH
Last Name:CASTRO
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5422 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 14-A
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4700
Mailing Address - Country:US
Mailing Address - Phone:602-843-1317
Mailing Address - Fax:602-547-1430
Practice Address - Street 1:5422 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 14-A
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4700
Practice Address - Country:US
Practice Address - Phone:602-843-1317
Practice Address - Fax:602-547-1430
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ12701207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ210691-01Medicaid
AZ210691-01Medicaid