MEDICARE: GREGORIO S SANTOS 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	207R00000X	Internal Medicine Physician	ME0072417	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417060369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORIO S SANTOS MD

Provider Business Mailing Address
First Line	:	6125 54TH AVE N
Second Line	:	SUITE B
City	:	KENNETH CITY
State	:	FL
Zip	:	33709-1807
Country	:	US
Telephone Number	:	727-521-9467
Fax Number	:	727-521-0416

Provider Business Practice Location Address
First Line	:	6125 54TH AVE N
Second Line	:	SUITE B
City	:	KENNETH CITY
State	:	FL
Zip	:	33709-1807
Country	:	US
Telephone Number	:	727-521-9467
Fax Number	:	727-521-0416

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	10/14/2010

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