Provider Demographics
NPI:1285667188
Name:SANTIAGO, JOSEPH PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PATRICK
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 1:1110 PARKER SQ
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7432
Mailing Address - Country:US
Mailing Address - Phone:972-724-1707
Mailing Address - Fax:972-724-1407
Practice Address - Street 1:1110 PARKER SQ
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7432
Practice Address - Country:US
Practice Address - Phone:972-724-1707
Practice Address - Fax:972-724-1407
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080155141OtherRR MEDICARE
TX87940YOtherBCBS
TX038856301Medicaid
TX080155141OtherRR MEDICARE
TX8149K0Medicare ID - Type Unspecified