Provider Demographics
NPI:1508961442
Name:CASTLES, JOE BLAIR III (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:BLAIR
Last Name:CASTLES
Suffix:III
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 1:14 RICHLAND MEDICAL PARK DR
Mailing Address - Street 2:STE. 410
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6877
Mailing Address - Country:US
Mailing Address - Phone:803-799-9044
Mailing Address - Fax:803-256-8119
Practice Address - Street 1:14 RICHLAND MEDICAL PARK DR
Practice Address - Street 2:STE. 410
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6877
Practice Address - Country:US
Practice Address - Phone:803-799-9044
Practice Address - Fax:803-256-8119
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22534208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC225349Medicaid
SC225349Medicaid
SCH90230Medicare UPIN