Provider Demographics
NPI:1649378506
Name:CASTRO, JOSE RAMON (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAMON
Last Name:CASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-0560
Mailing Address - Country:US
Mailing Address - Phone:912-345-8979
Mailing Address - Fax:912-345-8970
Practice Address - Street 1:1205 VAN STREAT HWY
Practice Address - Street 2:
Practice Address - City:NICHOLLS
Practice Address - State:GA
Practice Address - Zip Code:31554-5025
Practice Address - Country:US
Practice Address - Phone:912-345-8979
Practice Address - Fax:912-345-8970
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00195588CMedicaid
08BDGPROtherPIN
08BDGPROtherPIN