Basic Information
| Provider Information | |||||||||
| NPI: | 1073735155 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTOR | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | RANDALL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2029 | ||||||||
| Address2: | |||||||||
| City: | BRYSON CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287135029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285384546 | ||||||||
| FaxNumber: | 8285384549 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 VETERAN'S BLVD | ||||||||
| Address2: | |||||||||
| City: | BRYSON CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287134200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285384846 | ||||||||
| FaxNumber: | 8285384847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 81856 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 57-012724 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2010-0599 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 818565 | 05 | SC | MEDICAID |