Provider Demographics
NPI:1831898030
Name:CASTELLON CASTELLON, SAMIR ALEXANDER II (PHD, MD)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:ALEXANDER
Last Name:CASTELLON CASTELLON
Suffix:II
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1141 SW 10TH ST REAR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-3611
Mailing Address - Country:US
Mailing Address - Phone:305-522-7217
Mailing Address - Fax:907-313-1400
Practice Address - Street 1:1141 SW 10TH ST REAR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-3611
Practice Address - Country:US
Practice Address - Phone:305-522-7217
Practice Address - Fax:907-313-1400
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL10776141208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1104525443Medicaid