MEDICARE: PERRY M. SANTOS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	20098	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053418913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERRY M. SANTOS M.D.

Provider Business Mailing Address
First Line	:	3435 NW 56TH ST
Second Line	:	BLDG A, SUITE 412
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4448
Country	:	US
Telephone Number	:	405-945-4325
Fax Number	:	405-945-4327

Provider Business Practice Location Address
First Line	:	3435 NW 56TH ST
Second Line	:	BLDG A, SUITE 412
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4448
Country	:	US
Telephone Number	:	405-945-4325
Fax Number	:	405-945-4327

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/21/2008

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