MEDICARE: JUAN EUGENIO SANTIAGO MD

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME9780	FL
2	207L00000X	Anesthesiology Physician	ME97800	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	90250	OTHER	FL	BCBS
2	7592578	OTHER	FL	AETNA

General Provider Information

NPI Number	:	1275521957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN EUGENIO SANTIAGO MD

Provider Business Mailing Address
First Line	:	6586 HYPOLUXO RD STE 334
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7678
Country	:	US
Telephone Number	:	877-412-7272
Fax Number	:

Provider Business Practice Location Address
First Line	:	6586 HYPOLUXO RD STE 334
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7678
Country	:	US
Telephone Number	:	877-412-7272
Fax Number	:

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	04/08/2021

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