Provider Demographics
NPI:1366413338
Name:SANTIAGO, JOSEPH SANTOS (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SANTOS
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2900 LEMAY FERRY RD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3900
Mailing Address - Country:US
Mailing Address - Phone:314-894-8865
Mailing Address - Fax:314-894-7409
Practice Address - Street 1:2900 LEMAY FERRY RD
Practice Address - Street 2:SUITE 217
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-3900
Practice Address - Country:US
Practice Address - Phone:314-894-8865
Practice Address - Fax:314-894-7409
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO36856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202431904Medicaid
MO202431904Medicaid
MO202431904Medicaid