Provider Demographics
NPI:1376511873
Name:CASTRO, VICTOR J (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:J
Last Name:CASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:956-630-5522
Mailing Address - Fax:956-682-7730
Practice Address - Street 1:500 E RIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1508
Practice Address - Country:US
Practice Address - Phone:956-630-5522
Practice Address - Fax:956-682-7730
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP139207RC0000X, 207RI0011X
MO2017024259207RI0011X
TXL4284207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO58235012OtherBCBS
KY7100479070Medicaid
TX153421602Medicaid
IN300006942Medicaid
TX1A3287OtherMEDICARE PTAN
AR340419YYOPMedicare PIN
TX153421601Medicaid