Provider Demographics
NPI:1134179245
Name:SANTIAGO, EVE T (PA)
Entity type:Individual
Prefix:MRS
First Name:EVE
Middle Name:T
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:A
Other - Last Name:TOLEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:805 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1636
Mailing Address - Country:US
Mailing Address - Phone:205-939-3699
Mailing Address - Fax:205-581-7155
Practice Address - Street 1:805 SAINT VINCENTS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1636
Practice Address - Country:US
Practice Address - Phone:205-939-3699
Practice Address - Fax:205-581-7155
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA423363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51529672OtherBCBS
AL51010725OtherBCBS OF AL
AL51529672OtherBCBS
051556443TOLMedicare ID - Type Unspecified