Provider Demographics
NPI:1659672533
Name:JOSE R. CASTRO M.D., P.C.
Entity Type:Organization
Organization Name:JOSE R. CASTRO M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-632-8979
Mailing Address - Street 1:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-0560
Mailing Address - Country:US
Mailing Address - Phone:912-632-8979
Mailing Address - Fax:912-632-8970
Practice Address - Street 1:410 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-2142
Practice Address - Country:US
Practice Address - Phone:912-632-8979
Practice Address - Fax:912-632-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021385261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00195588CMedicaid
GA00195588CMedicaid