Provider Demographics
NPI:1417989203
Name:CASTILLO, JULIO CESAR (MD)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:CESAR
Last Name:CASTILLO
Suffix:
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6483
Mailing Address - Fax:682-885-3113
Practice Address - Street 1:4100 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-3123
Practice Address - Country:US
Practice Address - Phone:945-204-4100
Practice Address - Fax:682-885-1903
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4292208000000X
TNMD 199222080P0204X
FLME 681382080P0204X
LA12040R2080P0204X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4133781OtherBLUE CROSS
GA000562856RMedicaid
AL009910797Medicaid
LA1531839Medicaid
TN3827853Medicaid
LA1531839Medicaid
TN3827853Medicare PIN
TN4133781OtherBLUE CROSS
LA5H074Medicare ID - Type Unspecified