Provider Demographics
NPI:1972577377
Name:SANTOS, ADAMASTOR A (PA-C)
Entity Type:Individual
Prefix:
First Name:ADAMASTOR
Middle Name:A
Last Name:SANTOS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10040 SE 42ND CT
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-6858
Mailing Address - Country:US
Mailing Address - Phone:352-274-4307
Mailing Address - Fax:
Practice Address - Street 1:10040 SE 42ND CT
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-6858
Practice Address - Country:US
Practice Address - Phone:352-274-4307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101931207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291307100Medicaid
FLE7637OMedicare PIN
P62397Medicare UPIN