Provider Demographics
NPI:1023121613
Name:SANTIAGO, JOSE F (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:F
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 1:2624 W WILLIAM CANNON DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5251
Mailing Address - Country:US
Mailing Address - Phone:512-443-7746
Mailing Address - Fax:512-443-6367
Practice Address - Street 1:2624 W WILLIAM CANNON DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5251
Practice Address - Country:US
Practice Address - Phone:512-443-7746
Practice Address - Fax:512-443-6367
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3408174400000X, 207PE0004X, 207Q00000X
PR007936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133386601Medicaid
TX133386605Medicaid
000773GMedicare PIN
TX133386605Medicaid