Provider Demographics
NPI:1538138391
Name:CASTLE, WILLIAM BRAD (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRAD
Last Name:CASTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:901-227-3255
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:6250 OLD CANTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2946
Practice Address - Country:US
Practice Address - Phone:601-957-1015
Practice Address - Fax:601-956-9721
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2018-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS17650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08655383Medicaid
MS168390701OtherUS DEPT OF LABOR
MS7729458OtherAETNA
MS753068151Other1ST CHOICE
MSP00033300OtherRR MEDICARE
MS753068151OtherMS PHYSICIANS CARE NETWOR
MS$$$$$$$$$AOtherBCBS
MS$$$$$$$$$BOtherBCBS
MS753068151OtherMS HEALTH PARTNERS
MS753068151003OtherTRICARE
MS08655383Medicaid
MS753068151OtherMS PHYSICIANS CARE NETWOR
MSH86322Medicare UPIN