Healthcare Provider Details

I. General information

NPI: 1962697987
Provider Name (Legal Business Name): PERRY M. SANTOS MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 NW 56TH ST BLDG A, SUITE 412
OKLAHOMA CITY OK
73112-4448
US

IV. Provider business mailing address

3435 NW 56TH ST BLDG A, SUITE 412
OKLAHOMA CITY OK
73112-4448
US

V. Phone/Fax

Practice location:
  • Phone: 405-946-5563
  • Fax: 405-947-6626
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number20098
License Number StateOK

VIII. Authorized Official

Name: CLARENCE VOTH
Title or Position: BUSINESS MANAGER
Credential:
Phone: 405-946-5563