Healthcare Provider Details

I. General information

NPI: 1093756108
Provider Name (Legal Business Name): PAUL F CASTELLANOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH STREET SOUTH
BIRMINGHAM AL
35233
US

IV. Provider business mailing address

770 W HIGH ST STE 460
LIMA OH
45801-5908
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-6600
  • Fax:
Mailing address:
  • Phone: 205-572-1506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number26739
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35138760
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: