Provider Demographics
NPI:1922088533
Name:SANTOS, JOSE HUMBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:HUMBERTO
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 432040
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33243-2040
Mailing Address - Country:US
Mailing Address - Phone:954-384-2522
Mailing Address - Fax:954-384-2523
Practice Address - Street 1:1601 TOWN CENTER CIRC
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326
Practice Address - Country:US
Practice Address - Phone:954-384-2522
Practice Address - Fax:954-384-2523
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55388207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062067000Medicaid
FL08819OtherBCBS
FL08819SMedicare ID - Type Unspecified
FL08819RMedicare ID - Type Unspecified
FL08819TMedicare ID - Type Unspecified
FL08819VMedicare ID - Type Unspecified
FL08819XMedicare ID - Type Unspecified
FL08819UMedicare ID - Type Unspecified
FL062067000Medicaid