MEDICARE: PATRICK C 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	207Q00000X	Family Medicine Physician	M001195	GU

General Provider Information

NPI Number	:	1609937762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK C SANTOS MD

Provider Business Mailing Address
First Line	:	125 CARLOS LN
Second Line	:
City	:	TAMUNING
State	:	GU
Zip	:	96913-4339
Country	:	US
Telephone Number	:	671-649-5052
Fax Number	:	671-649-5054

Provider Business Practice Location Address
First Line	:	125 CARLOS LANE
Second Line	:	CARLOS HEIGHTS
City	:	UPPER TUMON
State	:	GU
Zip	:	96913
Country	:	US
Telephone Number	:	671-649-5052
Fax Number	:	671-649-5054

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	09/13/2016

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