Provider Demographics
NPI:1407152093
Name:DR LEONOR SANTOS M.D. GASTROENTEROLOGY LLC
Entity Type:Organization
Organization Name:DR LEONOR SANTOS M.D. GASTROENTEROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-404-8840
Mailing Address - Street 1:255 CITRUS TOWER BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2756
Mailing Address - Country:US
Mailing Address - Phone:352-404-8840
Mailing Address - Fax:352-404-8842
Practice Address - Street 1:255 CITRUS TOWER BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2756
Practice Address - Country:US
Practice Address - Phone:352-404-8840
Practice Address - Fax:352-404-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77216173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherIRS