Provider Demographics
NPI:1023097581
Name:SANTOS, ALFREDO G (MD)
Entity type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:G
Last Name:SANTOS
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 1:3 S POMPANO PKWY
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3001
Mailing Address - Country:US
Mailing Address - Phone:954-974-8901
Mailing Address - Fax:954-970-5382
Practice Address - Street 1:3 S POMPANO PKWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3001
Practice Address - Country:US
Practice Address - Phone:954-974-8901
Practice Address - Fax:954-970-5382
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 45695208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053084100Medicaid
FL053084100Medicaid
FLD61127Medicare UPIN