Provider Demographics
NPI:1124219381
Name:CASTRO-OTERO, JORGE HUMBERTO (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:HUMBERTO
Last Name:CASTRO-OTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:870-673-2511
Mailing Address - Fax:870-673-2518
Practice Address - Street 1:1703 N BUERKLE ST STE 1
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-3153
Practice Address - Country:US
Practice Address - Phone:870-673-2511
Practice Address - Fax:870-673-2518
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT 1895392086S0102X
ARE-18811208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Single Specialty