Provider Demographics
NPI:1184926602
Name:SANTIAGO, BRYAN (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
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:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-0510
Mailing Address - Country:US
Mailing Address - Phone:509-837-1500
Mailing Address - Fax:
Practice Address - Street 1:208 N EUCLID RD
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-9470
Practice Address - Country:US
Practice Address - Phone:509-882-1855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-04
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60395006207QA0505X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine