MEDICARE: DR. JAIME H CASTRO 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	174400000X	Specialist	F7419	TX

General Provider Information

NPI Number	:	1932159951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAIME H CASTRO M.D

Provider Business Mailing Address
First Line	:	1650 WEST ROSEDALE, SUITE 306
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7400
Country	:	US
Telephone Number	:	817-334-0137
Fax Number	:	817-334-0143

Provider Business Practice Location Address
First Line	:	1650 WEST ROSEDALE, SUITE 306
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7400
Country	:	US
Telephone Number	:	817-334-0137
Fax Number	:	817-334-0143

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	06/24/2019

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