Provider Demographics
NPI:1659474773
Name:SANTOS, EDWARD RAINIER GAMBOA (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD RAINIER
Middle Name:GAMBOA
Last Name:SANTOS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:651-968-5201
Mailing Address - Fax:651-968-5904
Practice Address - Street 1:15700 37TH AVE N STE 150
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3675
Practice Address - Country:US
Practice Address - Phone:651-968-5201
Practice Address - Fax:651-968-5904
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2021-03-09
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN47367207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery