MEDICARE: DR. EDUARDO LORENZO 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
1	207VG0400X	Gynecology Physician	8912	AL

General Provider Information

NPI Number	:	1609858174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDUARDO LORENZO SANTIAGO M.D.

Provider Business Mailing Address
First Line	:	15225 HIGHWAY 43
Second Line	:
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-1969
Country	:	US
Telephone Number	:	256-332-4465
Fax Number	:	256-332-6771

Provider Business Practice Location Address
First Line	:	15225 HIGHWAY 43
Second Line	:
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-1999
Country	:	US
Telephone Number	:	256-332-4465
Fax Number	:	256-332-6771

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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