Provider Demographics
NPI:1982657672
Name:SANTOS, LOUISE OYCO (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:OYCO
Last Name:SANTOS
Suffix:
Gender:F
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 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-0744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:
Practice Address - Street 1:2939 ALT 19
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1928
Practice Address - Country:US
Practice Address - Phone:727-785-2298
Practice Address - Fax:813-635-7944
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270458700Medicaid
FLP00231109OtherRAILROAD MEDICARE
FL270458700Medicaid
I16708Medicare UPIN