Provider Demographics
NPI:1407919269
Name:CASTRO, ROBERT SAUL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SAUL
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:SAUL
Other - Last Name:CASTRO GUZMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11509 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6568
Mailing Address - Country:US
Mailing Address - Phone:405-262-7631
Mailing Address - Fax:405-262-8099
Practice Address - Street 1:1631 A EAST HWY 66
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036
Practice Address - Country:US
Practice Address - Phone:405-262-7631
Practice Address - Fax:405-262-8099
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065570208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK9107004Medicaid
OK9107004Medicaid
OKC77630Medicare UPIN