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General NPI Number Information
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NPI Number | 1235307638
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Entity Type | Organization
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Legal Business Name | MATTHEW P. CASTNER, D.O., P.A.
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 1000 WATERMAN WAY
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City | TAVARES
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State | FL
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Zip | 32778-5266
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Country | US
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Telephone | 407-886-8164
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1411
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City | EUSTIS
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State | FL
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Zip | 32727-1411
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Country | US
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Telephone | 407-886-8164
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW P CASTNER
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Credential | D.O.
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Telephone | 407-886-8164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS0006305
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License Number State | FL
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