Provider Demographics
NPI:1851343511
Name:CASTANEDA, ANTONIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:A
Last Name:CASTANEDA
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 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-698-9703
Practice Address - Street 1:1325 PENNSYLVANIA AVE
Practice Address - Street 2:STE 777
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2144
Practice Address - Country:US
Practice Address - Phone:817-698-9700
Practice Address - Fax:817-698-9703
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2318208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00464339OtherRAIL ROAD MEDICARE
TX104582505Medicaid