=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558328914
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JON CURTIS CASTER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2006
-----------------------------------------------------
Last Update Date | 12/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1105 N UNIVERSITY DR
-----------------------------------------------------
City | NACOGDOCHES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75961-4211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-560-5437
-----------------------------------------------------
Fax | 936-560-1341
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 631624
-----------------------------------------------------
City | NACOGDOCHES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75963-1624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-560-5437
-----------------------------------------------------
Fax | 936-560-1341
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | J2526
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------