Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | M4511 | TX |
NPI | 1013926039 |
---|---|
Provider Name | Raul A Santos JR. |
First Address | Grapevine, TX 76051-3580 |
Second Address | Grapevine, TX 76051-3580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 18/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
084143902 | (05) | TX |
184143901 | (05) | TX |
184143903 | (05) | TX |
8CX371 | BCBSTX (01) | TX |
8G9672 | BCBS (01) | TX |
H58367 | (02) | TX |
P00360598 | RAILROAD MEDICARE (01) | TX |