Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2698 | TX |
NPI | 1952412512 |
---|---|
Provider Name | Dr. Dennis August Santo |
First Address | Tyler, TX 75703-4424 |
Second Address | Tyler, TX 75703-4424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
601005 | BLUE CROSS BLUE SHIELD (01) | TX |