Healthcare Provider Details

I. General information

NPI: 1639272073
Provider Name (Legal Business Name): FRANK ANTHONY SANTOLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24988 SE STARK ST STE 104
GRESHAM OR
97030-8322
US

IV. Provider business mailing address

24988 SE STARK ST STE 104
GRESHAM OR
97030-8322
US

V. Phone/Fax

Practice location:
  • Phone: 971-262-9500
  • Fax: 971-262-9501
Mailing address:
  • Phone: 971-262-9500
  • Fax: 971-262-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD177711
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier35703
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerBCBS
# 2
Identifier259392100
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: