Individual
DR. JERRY JAMES CASTLEBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1120 S UTICA AVE, TULSA, OK 74104-4012
(918) 579-1000
Mailing address
1120 S UTICA AVE, TULSA, OK 74104-4012
(918) 579-1000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
1927
ME
207P00000X
Emergency Medicine Physician
Primary
4481
OK
207P00000X
Emergency Medicine Physician
L8642
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8P9112
BLUE SHIELD
TX
Enumeration date
04/03/2006
Last updated
10/24/2007
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