Provider Demographics
NPI:1538179536
Name:CASTILLO, JAIME D JR (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:D
Last Name:CASTILLO
Suffix:JR
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:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-0432
Mailing Address - Country:US
Mailing Address - Phone:662-456-3700
Mailing Address - Fax:662-456-1717
Practice Address - Street 1:1002 E MADISON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-2428
Practice Address - Country:US
Practice Address - Phone:662-456-3000
Practice Address - Fax:662-456-9439
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07421365Medicaid
MS07421365Medicaid