Healthcare Provider Details

I. General information

NPI: 1740382332
Provider Name (Legal Business Name): RAMON A CASTILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 PRUDENTIAL DR SUITE 1800
JACKSONVILLE FL
32207-8334
US

IV. Provider business mailing address

1500 CONCORD TER
SUNRISE FL
33323-2815
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-7684
  • Fax: 904-398-4998
Mailing address:
  • Phone: 800-243-3839
  • Fax: 855-527-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME 55233
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: