Provider Demographics
NPI:1417004789
Name:JORGE SANTANDER MD PA
Entity Type:Organization
Organization Name:JORGE SANTANDER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-223-1140
Mailing Address - Street 1:4080 SW 84TH AVE
Mailing Address - Street 2:STE D
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4201
Mailing Address - Country:US
Mailing Address - Phone:305-223-1140
Mailing Address - Fax:305-223-1174
Practice Address - Street 1:4080 SW 84TH AVE
Practice Address - Street 2:STE D
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4201
Practice Address - Country:US
Practice Address - Phone:305-223-1140
Practice Address - Fax:305-223-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAA113Medicare PIN