Provider Demographics
NPI:1154346252
Name:CASTLEBERRY, TARAH LEANNE (DO)
Entity type:Individual
Prefix:DR
First Name:TARAH
Middle Name:LEANNE
Last Name:CASTLEBERRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TARAH
Other - Middle Name:LEANNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:310 COUNTY ROAD 14
Mailing Address - Street 2:
Mailing Address - City:DEL NORTE
Mailing Address - State:CO
Mailing Address - Zip Code:81132-8758
Mailing Address - Country:US
Mailing Address - Phone:719-657-2510
Mailing Address - Fax:719-657-2511
Practice Address - Street 1:1033 2ND AVE
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1737
Practice Address - Country:US
Practice Address - Phone:719-852-8827
Practice Address - Fax:719-852-2739
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4694207Q00000X
VA01022010932083A0100X
CODR.0067875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine