Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | M8316 | TX |
NPI | 1013055813 |
---|---|
Provider Name | Dr. Antonio Santillan-Gomez |
First Address | Dallas, TX 75391-1230 |
Second Address | San Antonio, TX 78229-3822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 11/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
188777002 | (05) | TX |
188777003 | (05) | TX |
206018803 | (05) | TX |
8CH834 | BCBS (01) | TX |
P01701266 | RAILROAD (01) | TX |