Provider Demographics
NPI:1457375388
Name:CASTLE, EVERETT R JR (MD)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:R
Last Name:CASTLE
Suffix:JR
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 17689
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85731-7689
Mailing Address - Country:US
Mailing Address - Phone:520-885-2231
Mailing Address - Fax:520-885-2471
Practice Address - Street 1:300 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2812
Practice Address - Country:US
Practice Address - Phone:800-880-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15498207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ299570Medicaid
AZ66209Medicare ID - Type UnspecifiedSW
AZE59816Medicare UPIN
AZ299570Medicaid
AZZ172142Medicare PIN