Provider Demographics
NPI:1124056072
Name:FLORES-SANTIAGO, ISMAEL (MD)
Entity type:Individual
Prefix:
First Name:ISMAEL
Middle Name:
Last Name:FLORES-SANTIAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 REUNION PARK DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-6870
Mailing Address - Country:US
Mailing Address - Phone:321-986-7417
Mailing Address - Fax:
Practice Address - Street 1:1001 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3825
Practice Address - Country:US
Practice Address - Phone:919-833-3111
Practice Address - Fax:919-834-3118
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28580207R00000X
NC2013-00354207R00000X
FLME106720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine