Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 001130 | IA |
NPI | 1114971058 |
---|---|
Provider Name | Wesley L Castle |
First Address | Dallas, TX 75284-6098 |
Second Address | Tyler, TX 75701-4443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 10/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8Y8942 | BCBS OF TEXAS (01) | TX |
P00075075 | RR MEDICARE (01) | IA |
P00128999 | RR MEDICARE (01) | IA |
S44629 | (02) | IA |
TIN PLUS 021 | TRICARE (01) | TX |