Provider Demographics
NPI:1811292899
Name:DR. LEONOR SANTOS M.D. GASTROENTEROLOGY, LLC
Entity type:Organization
Organization Name:DR. LEONOR SANTOS M.D. GASTROENTEROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-404-8840
Mailing Address - Street 1:PO BOX 121108
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-1108
Mailing Address - Country:US
Mailing Address - Phone:352-404-8840
Mailing Address - Fax:352-404-8842
Practice Address - Street 1:255 CITRUS TOWER BLVD STE 202
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1906
Practice Address - Country:US
Practice Address - Phone:352-404-8840
Practice Address - Fax:352-404-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77216207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty