Provider Demographics
NPI:1477612687
Name:CASTILLO, NORMAN W (DO)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:W
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 NW KINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1905
Mailing Address - Country:US
Mailing Address - Phone:541-757-2585
Mailing Address - Fax:541-757-2608
Practice Address - Street 1:1763 NW KINGS BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1905
Practice Address - Country:US
Practice Address - Phone:541-757-2585
Practice Address - Fax:541-757-2608
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO11252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR033647Medicaid
R118869Medicare ID - Type Unspecified
OR033647Medicaid