MEDICARE: DR. DAVID RANDALL CASTOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	81856	SC
2	207Q00000X	Family Medicine Physician	57-012724	OH
3	207Q00000X	Family Medicine Physician	2010-0599	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073735155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID RANDALL CASTOR M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2029
Second Line	:
City	:	BRYSON CITY
State	:	NC
Zip	:	28713-5029
Country	:	US
Telephone Number	:	828-538-4546
Fax Number	:	828-538-4549

Provider Business Practice Location Address
First Line	:	80 VETERAN'S BLVD
Second Line	:
City	:	BRYSON CITY
State	:	NC
Zip	:	28713-4200
Country	:	US
Telephone Number	:	828-538-4846
Fax Number	:	828-538-4847

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/24/2019

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