Healthcare Provider Details

I. General information

NPI: 1023093556
Provider Name (Legal Business Name): ANTHONY CASTILLO BIASCAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 836 BOX 556
FPO AE
09636-0010
US

IV. Provider business mailing address

PSC 836 BOX 556
FPO AE
09636-0010
US

V. Phone/Fax

Practice location:
  • Phone: 314-624-5331
  • Fax:
Mailing address:
  • Phone: 314-624-5331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number00024406
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberC52974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: