Healthcare Provider Details

I. General information

NPI: 1619953577
Provider Name (Legal Business Name): JOHN P CASTRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E BASELINE RD CJ HARRIS CLINIC
TEMPE AZ
85283-1511
US

IV. Provider business mailing address

982 CHAMBERS ST CJ HARRIS CLINIC
OGDEN UT
84403-4571
US

V. Phone/Fax

Practice location:
  • Phone: 480-345-5085
  • Fax: 480-345-5266
Mailing address:
  • Phone: 480-345-5085
  • Fax: 480-345-5266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35673
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: