Provider Demographics
NPI:1659483261
Name:SANTOS, ALBERTO III (DO)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:SANTOS
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12111 RANCH ROAD 12 STE 114
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-5245
Mailing Address - Country:US
Mailing Address - Phone:512-537-8950
Mailing Address - Fax:866-616-7615
Practice Address - Street 1:12111 RANCH ROAD 12 STE 114
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-5245
Practice Address - Country:US
Practice Address - Phone:512-537-8950
Practice Address - Fax:866-616-7615
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5125207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB149337OtherWELLMED MEDICAL GROUP PA
TX166643001Medicaid
TX166643001Medicaid
TXI09080Medicare UPIN