Provider Demographics
NPI:1558328914
Name:CASTER, JON CURTIS (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:CURTIS
Last Name:CASTER
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:PO BOX 631624
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-1624
Mailing Address - Country:US
Mailing Address - Phone:936-560-5437
Mailing Address - Fax:936-560-1341
Practice Address - Street 1:1105 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4211
Practice Address - Country:US
Practice Address - Phone:936-560-5437
Practice Address - Fax:936-560-1341
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2526174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134548007Medicaid
TX8978J0OtherMEDICARE
TXG03682Medicare UPIN