=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700836426
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CORAZON G. CASTILLO M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15155 HIGHWAY 43
-----------------------------------------------------
City | RUSSELLVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35653-1975
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-332-8679
-----------------------------------------------------
Fax | 256-332-8674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 216 MARENGO ST
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35630-6012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-764-9697
-----------------------------------------------------
Fax | 256-764-9699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 00004381
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------