Healthcare Provider Details

I. General information

NPI: 1023121613
Provider Name (Legal Business Name): JOSE F SANTIAGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 W WILLIAM CANNON DR
AUSTIN TX
78745-5251
US

IV. Provider business mailing address

2624 W WILLIAM CANNON DR
AUSTIN TX
78745-5251
US

V. Phone/Fax

Practice location:
  • Phone: 512-443-7746
  • Fax: 512-443-6367
Mailing address:
  • Phone: 512-443-7746
  • Fax: 512-443-6367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberJ3408
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberJ3408
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number007936
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ3408
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: