Provider Demographics
NPI:1982679460
Name:HOYOS, SANTIAGO M (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:SANTIAGO
Middle Name:M
Last Name:HOYOS
Suffix:
Gender:M
Credentials:MD, PA
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 340070
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33694-0070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7040 LAND O LAKES BLVD
Practice Address - Street 2:UNIT 101
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-3232
Practice Address - Country:US
Practice Address - Phone:813-948-1211
Practice Address - Fax:813-948-1211
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34089208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068295100Medicaid
FL068295100Medicaid