Provider Demographics
NPI:1679671853
Name:SANTOS, ALEJANDRO (MD)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:SANTOS
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 764307
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75376-4307
Mailing Address - Country:US
Mailing Address - Phone:214-707-1308
Mailing Address - Fax:
Practice Address - Street 1:2700 W PLEASANT RUN RD
Practice Address - Street 2:SUITE 240
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1079
Practice Address - Country:US
Practice Address - Phone:469-297-5471
Practice Address - Fax:469-297-5614
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1725208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G17XOtherBLUE CROSS/BLUE SHIELD
TX138782101Medicaid
TX138782101Medicaid
TX138782101Medicaid