Provider Demographics
NPI:1013926039
Name:SANTOS, RAUL A JR (MD)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:A
Last Name:SANTOS
Suffix:JR
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 1:1600 W COLLEGE ST
Mailing Address - Street 2:SUITE 680
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3580
Mailing Address - Country:US
Mailing Address - Phone:817-912-8400
Mailing Address - Fax:817-912-8410
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:SUITE 680
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3580
Practice Address - Country:US
Practice Address - Phone:817-912-8400
Practice Address - Fax:817-912-8410
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4511207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184143903Medicaid
TXP00360598OtherRAILROAD MEDICARE
TX8CX371OtherBCBSTX
TX184143901Medicaid
TX8G9672OtherBCBS
TX084143902Medicaid
TX184143903Medicaid
TXTXB138385Medicare PIN
TX184143901Medicaid
TX8J0245Medicare PIN
TXP01010993Medicare PIN