Healthcare Provider Details

I. General information

NPI: 1689661712
Provider Name (Legal Business Name): ANDREW CECIL CASTRODALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 FORTUYN RD
GRAND COULEE WA
99133-8718
US

IV. Provider business mailing address

411 FORTUYN RD
GRAND COULEE WA
99133-8718
US

V. Phone/Fax

Practice location:
  • Phone: 509-633-1753
  • Fax: 509-633-1930
Mailing address:
  • Phone: 509-633-1911
  • Fax: 509-633-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00034115
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00034115
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: