Provider Demographics
NPI:1679837181
Name:CASTILLO LIRANZO, MARTIN A (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:A
Last Name:CASTILLO LIRANZO
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 728
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-0728
Mailing Address - Country:US
Mailing Address - Phone:620-801-4380
Mailing Address - Fax:620-801-4383
Practice Address - Street 1:112 W ROSS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-7219
Practice Address - Country:US
Practice Address - Phone:620-801-4380
Practice Address - Fax:620-801-4383
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0438035208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics