Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | L5125 | TX |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | L5125 | TX |
NPI | 1659483261 |
---|---|
Provider Name | Alberto Santos III |
First Address | Wimberley, TX 78676-5245 |
Second Address | Wimberley, TX 78676-5245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 24/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I09080 | (02) | TX |