Healthcare Provider Details

I. General information

NPI: 1972695724
Provider Name (Legal Business Name): JULIO ENRIQUE CASTRO-QUERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 COOLIDGE BLVD
LAFAYETTE LA
70503-2621
US

IV. Provider business mailing address

PO BOX 62600 DEPT. 1721
NEW ORLEANS LA
70162-2600
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-7991
  • Fax:
Mailing address:
  • Phone: 337-706-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number023327
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: