Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | J3408 | TX |
N | 207Q00000X | Family Doctor | 007936 | PR |
Y | 207Q00000X | Family Doctor | J3408 | TX |
NPI | 1023121613 |
---|---|
Provider Name | Jose F Santiago |
First Address | Austin, TX 78745-5251 |
Second Address | Austin, TX 78745-5251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 28/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133386601 | (05) | TX |
133386605 | (05) | TX |