Provider Demographics
NPI:1669554952
Name:SANTIAGO, JOSE ANGEL JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANGEL
Last Name:SANTIAGO
Suffix:JR
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 1:1200 HOSPITAL DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6552
Mailing Address - Country:US
Mailing Address - Phone:337-948-7090
Mailing Address - Fax:
Practice Address - Street 1:1200 HOSPITAL DR
Practice Address - Street 2:SUITE 4
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6552
Practice Address - Country:US
Practice Address - Phone:337-948-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024044207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1497843Medicaid
LA024044OtherSTATE MEDICAL LICENSE
LA024044OtherSTATE MEDICAL LICENSE
LAH77753Medicare UPIN