Provider Demographics
NPI:1245408616
Name:RAMON SANTIAGO M D P A
Entity Type:Organization
Organization Name:RAMON SANTIAGO M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-988-1984
Mailing Address - Street 1:13250 N 56TH ST
Mailing Address - Street 2:SUITE101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1107
Mailing Address - Country:US
Mailing Address - Phone:813-988-1984
Mailing Address - Fax:813-988-0240
Practice Address - Street 1:13250 N 56TH ST
Practice Address - Street 2:SUITE101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1107
Practice Address - Country:US
Practice Address - Phone:813-988-1984
Practice Address - Fax:813-988-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI546Medicare PIN