Provider Demographics
NPI:1134186794
Name:CASTRO, GERMAN (MD)
Entity type:Individual
Prefix:MR
First Name:GERMAN
Middle Name:
Last Name:CASTRO
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 1:1091 PORT MALABAR BLVD NE SUITE-1
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905
Mailing Address - Country:US
Mailing Address - Phone:321-728-7222
Mailing Address - Fax:321-728-8823
Practice Address - Street 1:1091 PORT MALABAR BLVD NE SUITE-1
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5100
Practice Address - Country:US
Practice Address - Phone:321-728-7222
Practice Address - Fax:321-728-8823
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51319Medicare UPIN
FL05494Medicare PIN
FLD51319Medicare UPIN