Provider Demographics
NPI:1013923713
Name:SANTIAGO, RAMON (MD)
Entity type:Individual
Prefix:MR
First Name:RAMON
Middle Name:
Last Name:SANTIAGO
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 1:13250 N 56TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2238
Mailing Address - Country:US
Mailing Address - Phone:813-988-1984
Mailing Address - Fax:813-988-0240
Practice Address - Street 1:13250 N 56TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-2238
Practice Address - Country:US
Practice Address - Phone:813-988-1984
Practice Address - Fax:813-988-0240
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00038490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03920OtherBLUE CROSS BLUE SHIELD
FLD60987Medicare UPIN
FL03920OtherBLUE CROSS BLUE SHIELD