Provider Demographics
NPI:1659396406
Name:SANTIAGO, CESAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:A
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:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:4301 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6546
Practice Address - Country:US
Practice Address - Phone:813-879-5010
Practice Address - Fax:813-443-8148
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95270208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019521700Medicaid
FL2842917-003OtherCIGNA PROVIDER #
FLP00380791OtherRR MEDICARE
FL2761165-01Medicaid
FL54300OtherBCBS FL PROVIDER #
FL7615833OtherAETNA PROVIDER #
FL276116500Medicaid
FLME95270OtherMETCARE PROVIDER #
FL54300OtherBCBS FL PROVIDER #
FLI58303Medicare UPIN
FLU7913XMedicare PIN