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NPI Code Detail

MEDICARE: DR. RAFAEL SANTIAGO M.D.

MEDICARE: DR. RAFAEL SANTIAGO 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
1207Q00000XFamily Medicine Physician2004020481MO
2207Q00000XFamily Medicine PhysicianMD2011-0716NM

General Provider Information

NPI Number : 1174517825
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAFAEL SANTIAGO M.D.
Provider Business Mailing Address
First Line : 440 E TAMPA ST
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65806-1131
Country : US
Telephone Number : 417-831-0150
Fax Number :
Provider Business Practice Location Address
First Line : 440 E TAMPA ST
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65806-1131
Country : US
Telephone Number : 417-831-0150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2005
Last Update Date : 12/15/2015

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