PETER W CASTELLANOS


Address: 2225 Teton Plz Ste B, Idaho Falls, ID 83404-6494
Phone: 2085294300

PETER W CASTELLANOS (NPI# 1811991474) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1811991474
Entity Type Individual
Full Name PETER W CASTELLANOS
Credential MD
Practice Address 2225 Teton Plz Ste B
Idaho Falls
ID 83404-6494
Practice Telephone 2085294300
Practice Fax Number 2088815121
Mailing Telephone 2085294300
Mailing Fax Number 2088815121
Enumeration Date 2005-06-10
Last Update Date 2019-09-13
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 2084N0402X Psychiatry & Neurology
Specialization: Neurology with Special Qualifications in Child Neurology
M10191 ID Allopathic & Osteopathic Physicians
N 2084N0402X Psychiatry & Neurology
Specialization: Neurology with Special Qualifications in Child Neurology
01048179 IN Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
IN 200173520 05
IN ANTHEM BXBS 000000089466 01

Office Location

Street Address 2225 TETON PLZ STE B
City IDAHO FALLS
State ID
Zip Code 83404-6494

Providers in the same location

NPI Name Taxonomy Address Enumeration
1962734889 Lifetime Wellness Chiropractic Pllc Chiropractor 2225 Teton Plz Ste B, Idaho Falls, ID 83404-6494 2010-02-03
1306862503 Mountain States Cardiovascular And Specialist 2225 Teton Plz Ste B, Idaho Falls, ID 83404-6494 2006-07-14

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Taxonomy Information

Taxonomy Code 2084N0402X
Grouping Allopathic & Osteopathic Physicians
Classification Psychiatry & Neurology
Specialization Neurology with Special Qualifications in Child Neurology

Taxonomy Definition

A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence.
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1083817795 Lindsey M Foy Psychiatry & Neurology 100 E Idaho St, Suite 200, Boise, ID 83712-6267 2007-06-08
1053425603 David B Bettis Psychiatry & Neurology 100 E Idaho St, Ste 201, Boise, ID 83712-6267 2006-08-19

Competitor

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City IDAHO FALLS
Zip Code 83404

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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