Provider Demographics
NPI:1902250087
Name:CASTILHO, ALEXANDER JORDAN (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JORDAN
Last Name:CASTILHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7624 137TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-6418
Mailing Address - Country:US
Mailing Address - Phone:727-871-0076
Mailing Address - Fax:
Practice Address - Street 1:7624 137TH STREET CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-6418
Practice Address - Country:US
Practice Address - Phone:727-871-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA915772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology