Provider Demographics
NPI:1639260771
Name:SANTOS, EDGARDO (MD)
Entity type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:
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 1:500 SE 17TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2547
Mailing Address - Country:US
Mailing Address - Phone:754-336-3426
Mailing Address - Fax:754-241-4659
Practice Address - Street 1:500 SE 17TH ST STE 100
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2547
Practice Address - Country:US
Practice Address - Phone:754-336-3426
Practice Address - Fax:754-241-4659
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15621R207RH0003X
FLME83677207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1465801Medicaid
LAI21811Medicare UPIN
LA1465801Medicaid