Provider Demographics
NPI:1659313583
Name:KASTELER, DOUGLAS SPENCE (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:SPENCE
Last Name:KASTELER
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 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-475-3500
Mailing Address - Fax:801-475-3489
Practice Address - Street 1:185 S 400 E STE 100
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4862
Practice Address - Country:US
Practice Address - Phone:801-397-6200
Practice Address - Fax:801-397-6201
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1843601205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942854057086Medicaid
F77037Medicare UPIN
UT942854057086Medicaid