Basic Information
| Provider Information | |||||||||
| NPI: | 1043974538 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASTLE PHYSICIAN NETWORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 ULUKAHIKI ST | ||||||||
| Address2: | |||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967344454 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 660 KAILUA RD | ||||||||
| Address2: | |||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967342809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082632273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2021 | ||||||||
| LastUpdateDate: | 10/29/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DICKARD | ||||||||
| AuthorizedOfficialFirstName: | DEREK | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BUSINESS DEVELOPMENT | ||||||||
| AuthorizedOfficialTelephone: | 8082635011 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.