Provider Demographics
NPI:1275521957
Name:SANTIAGO, JUAN EUGENIO (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:EUGENIO
Last Name:SANTIAGO
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 1:6586 HYPOLUXO RD STE 334
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7678
Mailing Address - Country:US
Mailing Address - Phone:877-412-7272
Mailing Address - Fax:
Practice Address - Street 1:6586 HYPOLUXO RD STE 334
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7678
Practice Address - Country:US
Practice Address - Phone:877-412-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME9780207LP2900X
FLME97800207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL90250OtherBCBS
FL7592578OtherAETNA