Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ME 45695 | FL |
NPI | 1023097581 |
---|---|
Provider Name | Dr. Alfredo G. Santos |
First Address | Pompano Beach, FL 33069-3001 |
Second Address | Pompano Beach, FL 33069-3001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 06/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
053084100 | (05) | FL |
D61127 | (02) | FL |