Healthcare Provider Details

I. General information

NPI: 1689652281
Provider Name (Legal Business Name): EDWIN SANTOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 MAIN ST CAMPTON MEDICAL ARTS, SUITE I
CAMPTON KY
41301-9750
US

IV. Provider business mailing address

PO BOX 99
CAMPTON KY
41301-0099
US

V. Phone/Fax

Practice location:
  • Phone: 606-668-9076
  • Fax: 606-668-7488
Mailing address:
  • Phone: 606-668-9076
  • Fax: 606-668-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number32898
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number32898
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: