Individual
PETER W CASTELLANOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2225 TETON PLZ STE B, IDAHO FALLS, ID 83404-6494
(208) 529-4300
(208) 881-5121
Mailing address
2225 TETON PLZ STE B, IDAHO FALLS, ID 83404-6494
(208) 529-4300
(208) 881-5121
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
01048179
IN
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
M10191
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000089466
ANTHEM BXBS
IN
05
—
200173520
—
IN
Enumeration date
06/10/2005
Last updated
07/29/2021
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