Provider Demographics
NPI:1134204423
Name:SANTOS, FERDINAND JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:FERDINAND
Middle Name:JOSEPH
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 1:2685 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1412
Mailing Address - Country:US
Mailing Address - Phone:937-298-5333
Mailing Address - Fax:
Practice Address - Street 1:205 E PALMER RD
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2281
Practice Address - Country:US
Practice Address - Phone:937-441-8139
Practice Address - Fax:937-210-5351
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.072854207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2053030Medicaid
OHH070930Medicare PIN