Provider Demographics
NPI:1063423424
Name:SANTIAGO, RUBEN R (MD)
Entity type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:R
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RUBEN
Other - Middle Name:ROMERA
Other - Last Name:SANTIAGO-ROMERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3078 DYER BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7839
Mailing Address - Country:US
Mailing Address - Phone:407-518-1097
Mailing Address - Fax:407-518-1476
Practice Address - Street 1:3078 DYER BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7839
Practice Address - Country:US
Practice Address - Phone:407-518-1097
Practice Address - Fax:407-518-1476
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87512207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270204500Medicaid
FL37917OtherBCBS
FL0412152OtherCIGNA
FLU0876YMedicare PIN
FL37917OtherBCBS
U0876WMedicare PIN
FLU0876XMedicare PIN