Healthcare Provider Details

I. General information

NPI: 1629174917
Provider Name (Legal Business Name): JOSE A SANTANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 UNIVERSITY BLVD S EMERGENCY DEPARTMENT
JACKSONVILLE FL
32202
US

IV. Provider business mailing address

PO BOX 860554
ORLANDO FL
32886-0554
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-6811
  • Fax: 904-346-0113
Mailing address:
  • Phone: 904-346-3606
  • Fax: 904-346-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0095767
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: