Healthcare Provider Details

I. General information

NPI: 1609890474
Provider Name (Legal Business Name): ELQUIS M. CASTILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 GOODYEAR AVE
GADSDEN AL
35903-1156
US

IV. Provider business mailing address

PO BOX 131329
BIRMINGHAM AL
35213-6329
US

V. Phone/Fax

Practice location:
  • Phone: 256-492-0375
  • Fax: 256-492-9811
Mailing address:
  • Phone: 256-492-0375
  • Fax: 256-492-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number00016440
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: