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General NPI Number Information
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NPI Number | 1114971058
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Entity Type | Individual
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Provider Name | WESLEY L CASTLE P.A.-C
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Gender | Male
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 10/10/2014
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Provider Practice Location Address
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Address Line | 1327 TROUP HWY
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City | TYLER
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State | TX
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Zip | 75701-4443
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Country | US
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Telephone | 903-510-8840
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 846098
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City | DALLAS
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State | TX
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Zip | 75284-6098
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Country | US
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Telephone | 903-324-6450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 001130
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA04931
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License Number State | TX
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