Provider Demographics
NPI:1447209457
Name:CASTRO, JORGE W (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:W
Last Name:CASTRO
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 1:2200 LAKESHORE DRIVE
Mailing Address - Street 2:GRAYSON & ASSOCIATES SUITE 150
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:205-871-6926
Mailing Address - Fax:205-871-7981
Practice Address - Street 1:2200 LAKESHORE DRIVE
Practice Address - Street 2:GRAYSON & ASSOCIATES SUITE 150
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-871-6926
Practice Address - Fax:205-871-7981
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000180572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F80340Medicare UPIN