Provider Demographics
NPI:1952344566
Name:DE LOS SANTOS, JENNIFER LYNNE (MD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNNE
Last Name:DE LOS SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-747-7236
Mailing Address - Fax:314-362-7769
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DEPT RADIATION ONCOLOGY, LL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-7236
Practice Address - Fax:314-362-7769
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240043832085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200137932Medicaid
AL009934576Medicaid
AL009974920Medicaid
AL051513497OtherBLUE CROSS
AL051550519Medicaid
MS07724708Medicaid
AL009910367Medicaid
AL051504438OtherBLUE CROSS
AL920006247OtherRAILROAD MEDICARE
AL051502577OtherBLUE CROSS
AL051541877OtherBLUE CROSS
MS07724708Medicaid
AL009934576Medicaid