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General NPI Number Information
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NPI Number | 1124219381
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Entity Type | Individual
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Provider Name | JORGE HUMBERTO CASTRO-OTERO M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 1703 N BUERKLE ST STE 1
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City | STUTTGART
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State | AR
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Zip | 72160-3153
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Country | US
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Telephone | 870-673-2511
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Fax | 870-673-2518
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Provider Business Mailing Address
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Address Line | 11001 EXECUTIVE CENTER DR STE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72211-4393
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Country | US
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Telephone | 870-673-2511
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Fax | 870-673-2518
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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 | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | MT 189539
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | E-18811
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License Number State | AR
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