Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 056393 | GA |
N | 207T00000X | Neurosurgeon | 18840 | SC |
N | 207T00000X | Neurosurgeon | G5572 | TX |
N | 207T00000X | Neurosurgeon | MD425822 | PA |
NPI | 1083679252 |
---|---|
Provider Name | Dr. Jose A Santiago |
First Address | Augusta, GA 30904-6258 |
Second Address | Augusta, GA 30904-6258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 11/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E10198 | (02) | SC |
T26120 | (05) | SC |