MEDICARE: DANIEL CASTRO MD

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD0000056844	TN
2	208M00000X	Hospitalist Physician	MD0000056844	TN
3	207R00000X	Internal Medicine Physician	MD0000056844	TN

General Provider Information

NPI Number	:	1821002700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL CASTRO MD

Provider Business Mailing Address
First Line	:	31165 DANELAW AVE
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-7419
Country	:	US
Telephone Number	:	909-389-9196
Fax Number	:

Provider Business Practice Location Address
First Line	:	2231 SANDSTONE DR
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-2593
Country	:	US
Telephone Number	:	423-616-0625
Fax Number	:	423-616-0150

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	10/10/2023

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