Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 005096 | AZ |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 005096 | AZ |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 43871 | MN |
NPI | 1679505044 |
---|---|
Provider Name | Michael Dominic Castro |
First Address | Woodbury, MN 55125-4925 |
Second Address | Woodbury, MN 55125-2522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 01/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
342593 | (05) | AZ |