Provider Demographics
NPI:1649243320
Name:CAST, RAYMOND WILLARD JR (PA)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:WILLARD
Last Name:CAST
Suffix:JR
Gender:M
Credentials:PA
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 44008
Mailing Address - Street 2:UFJP NEUROSURGERY
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3660
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:580 W 8TH ST
Practice Address - Street 2:UFJP NEUROSURGERY
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6533
Practice Address - Country:US
Practice Address - Phone:904-244-3950
Practice Address - Fax:904-244-3425
Is Sole Proprietor?:No
Enumeration Date:2006-02-11
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100928363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100000365BMedicaid
GA100000365AMedicaid
FL2908662-00Medicaid
GA970015632Medicare PIN
FL2908662-00Medicaid
FLE3246YMedicare PIN
FL970015632Medicare PIN
FLE3246XMedicare PIN
GA100000365BMedicaid