Provider Demographics
NPI:1063630259
Name:SANTIAGO, LOURDES TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:TERESA
Last Name:SANTIAGO
Suffix:
Gender:F
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:PO BOX 1336
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-1336
Mailing Address - Country:US
Mailing Address - Phone:727-483-9188
Mailing Address - Fax:
Practice Address - Street 1:1305 S FORT HARRISON AVE
Practice Address - Street 2:BLDG C
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3301
Practice Address - Country:US
Practice Address - Phone:727-483-9188
Practice Address - Fax:727-412-8432
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97611208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery