Provider Demographics
NPI:1124891338
Name:DRASTOR
Entity type:Organization
Organization Name:DRASTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:JULIETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-900-0182
Mailing Address - Street 1:3101 SW COLLEGE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7444
Mailing Address - Country:US
Mailing Address - Phone:614-300-7830
Mailing Address - Fax:
Practice Address - Street 1:3101 SW COLLEGE RD STE 205
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7444
Practice Address - Country:US
Practice Address - Phone:614-600-7830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty