Provider Demographics
NPI:1457332074
Name:CASTANEDA, JORGE D (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:D
Last Name:CASTANEDA
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 1:2140 W 68TH ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1815
Mailing Address - Country:US
Mailing Address - Phone:305-822-4108
Mailing Address - Fax:786-497-2989
Practice Address - Street 1:2140 W 68TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1815
Practice Address - Country:US
Practice Address - Phone:305-822-4108
Practice Address - Fax:305-822-5086
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49405207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03739OtherBC/BS OF FL
FL046109100Medicaid
FL03739OtherBC/BS OF FL
FL046109100Medicaid