Healthcare Provider Details

I. General information

NPI: 1124219381
Provider Name (Legal Business Name): JORGE HUMBERTO CASTRO-OTERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 N BUERKLE ST STE 1
STUTTGART AR
72160-3153
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 870-673-2511
  • Fax: 870-673-2518
Mailing address:
  • Phone: 870-673-2511
  • Fax: 870-673-2518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMT 189539
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-18811
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: