Healthcare Provider Details

I. General information

NPI: 1609858174
Provider Name (Legal Business Name): EDUARDO LORENZO SANTIAGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15225 HIGHWAY 43
RUSSELLVILLE AL
35653-1999
US

IV. Provider business mailing address

15225 HIGHWAY 43
RUSSELLVILLE AL
35653-1969
US

V. Phone/Fax

Practice location:
  • Phone: 256-332-4465
  • Fax: 256-332-6771
Mailing address:
  • Phone: 256-332-4465
  • Fax: 256-332-6771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number8912
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: