Healthcare Provider Details

I. General information

NPI: 1104866375
Provider Name (Legal Business Name): FRANK CASTILLON III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 50TH SREET STE 100
LUBBOCK TX
79412-2549
US

IV. Provider business mailing address

2424 50TH ST SUITE 100
LUBBOCK TX
79412-2556
US

V. Phone/Fax

Practice location:
  • Phone: 806-761-0722
  • Fax: 806-797-1265
Mailing address:
  • Phone: 806-761-0722
  • Fax: 806-797-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberM0682
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: