MEDICARE: MR. JOSEPH SANTOS JR. MPAS, PA-C

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	363AM0700X	Medical Physician Assistant	608	TN

General Provider Information

NPI Number	:	1245213016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH SANTOS JR. MPAS, PA-C

Provider Business Mailing Address
First Line	:	U.S. EMBASSY-QUITO
Second Line	:	UNIT 5314
City	:	APO
State	:	AA
Zip	:	34039
Country	:	EC
Telephone Number	:	931-538-4109
Fax Number	:

Provider Business Practice Location Address
First Line	:	U.S. EMBASSY-QUITO
Second Line	:	UNIT 5314
City	:	APO
State	:	AA
Zip	:	34039
Country	:	EC
Telephone Number	:	931-538-4109
Fax Number	:

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

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	07/08/2007

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