MEDICARE: BRIAN CASTILLO 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	N1577	TX

General Provider Information

NPI Number	:	1922247881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN CASTILLO M.D.

Provider Business Mailing Address
First Line	:	7487 BROMPTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-2265
Country	:	US
Telephone Number	:	713-667-9896
Fax Number	:

Provider Business Practice Location Address
First Line	:	13176 W LAKE HOUSTON PKWY
Second Line	:	STE. 5
City	:	HOUSTON
State	:	TX
Zip	:	77044-5390
Country	:	US
Telephone Number	:	281-436-0061
Fax Number	:	281-436-1128

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

Provider Enumeration Date	:	02/16/2009
Last Update Date	:	04/29/2010

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