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NPI Code Detail

MEDICARE: JOSE RAFAEL LABAULT-SANTIAGO M.D.

MEDICARE: JOSE RAFAEL LABAULT-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
12084N0400XNeurology PhysicianP3375TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
114W87OTHERFLBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932358009
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE RAFAEL LABAULT-SANTIAGO M.D.
Provider Business Mailing Address
First Line : 5700 LAKE WORTH RD
Second Line : STE 204
City : GREENACRES
State : FL
Zip : 33463-4727
Country : US
Telephone Number : 561-966-7707
Fax Number :
Provider Business Practice Location Address
First Line : 140 JFK DR
Second Line :
City : ATLANTIS
State : FL
Zip : 33462-6608
Country : US
Telephone Number : 561-968-6767
Fax Number : 561-641-0814
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2008
Last Update Date : 02/27/2015

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