Provider Demographics
NPI:1790265932
Name:DEL CASTILLO, ANTONIO REYES JR
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:REYES
Last Name:DEL CASTILLO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 S FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-3609
Mailing Address - Country:US
Mailing Address - Phone:662-545-6414
Mailing Address - Fax:
Practice Address - Street 1:590 PARCHMAN ROAD 12
Practice Address - Street 2:
Practice Address - City:PARCHMAN
Practice Address - State:MS
Practice Address - Zip Code:38738-3001
Practice Address - Country:US
Practice Address - Phone:662-745-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS966-L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty