Provider Demographics
NPI:1295918464
Name:SANTA EULALIA, JOHANN L (MD)
Entity type:Individual
Prefix:DR
First Name:JOHANN
Middle Name:L
Last Name:SANTA EULALIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 SE OSCEOLA ST
Mailing Address - Street 2:STE 3
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2505
Mailing Address - Country:US
Mailing Address - Phone:772-286-0338
Mailing Address - Fax:772-287-1139
Practice Address - Street 1:421 SE OSCEOLA ST
Practice Address - Street 2:SUITE 3
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2505
Practice Address - Country:US
Practice Address - Phone:772-286-0338
Practice Address - Fax:772-287-1139
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432980207L00000X
FLME100397207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52185OtherBCBS FL
FLA0015ZMedicare PIN