Healthcare Provider Details

I. General information

NPI: 1972912467
Provider Name (Legal Business Name): JOHN SANTOGROSSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4864 JACKSON ST
MONROE LA
71202-6400
US

IV. Provider business mailing address

3111 OLD STERLINGTON RD APT 184
MONROE LA
71203-2624
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-7661
  • Fax:
Mailing address:
  • Phone: 972-839-5092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number6480
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number309560
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: