MEDICARE: KENNETH C CASTOR JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	20399	AL

General Provider Information

NPI Number	:	1457350662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH C CASTOR JR. M.D.

Provider Business Mailing Address
First Line	:	610 PROVIDENCE PARK DR E
Second Line	:	SUITE 201
City	:	MOBILE
State	:	AL
Zip	:	36695-4622
Country	:	US
Telephone Number	:	251-639-1300
Fax Number	:	251-639-1380

Provider Business Practice Location Address
First Line	:	610 PROVIDENCE PARK DR E
Second Line	:	SUITE 201
City	:	MOBILE
State	:	AL
Zip	:	36695-4622
Country	:	US
Telephone Number	:	251-639-1300
Fax Number	:	251-639-1380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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