=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427005149
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANTIAGO MARTINEZ-JIMENEZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2006
-----------------------------------------------------
Last Update Date | 11/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4401 WORNALL RD
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64111-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-932-2549
-----------------------------------------------------
Fax | 816-932-3939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 E 104TH ST MAILSTOP 400
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-502-7117
-----------------------------------------------------
Fax | 816-932-9670
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 2006-00004
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 2010019852
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------