Provider Demographics
NPI:1760454797
Name:CASTOR, STANLEY ASBURY (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:ASBURY
Last Name:CASTOR
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 1:5383 PRIMROSE LAKE CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3520
Mailing Address - Country:US
Mailing Address - Phone:813-971-2000
Mailing Address - Fax:
Practice Address - Street 1:5383 PRIMROSE LAKE CIR
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3520
Practice Address - Country:US
Practice Address - Phone:813-971-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78556208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G99909Medicare UPIN
46880ZMedicare ID - Type Unspecified