Provider Demographics
NPI:1205919602
Name:CASTILLO, RANDOLFO V (MD)
Entity type:Individual
Prefix:
First Name:RANDOLFO
Middle Name:V
Last Name:CASTILLO
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 4856
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523
Mailing Address - Country:US
Mailing Address - Phone:956-542-7502
Mailing Address - Fax:956-541-1958
Practice Address - Street 1:1040 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520
Practice Address - Country:US
Practice Address - Phone:956-544-1400
Practice Address - Fax:956-698-5445
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1867207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00FW07OtherBCBS
TX050056367OtherMEDICARE RR
TX137196508Medicaid
C14296Medicare UPIN
TX137196508Medicaid