Provider Demographics
NPI:1194780221
Name:SANTORA, STEPHEN D (MD)
Entity type:Individual
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First Name:STEPHEN
Middle Name:D
Last Name:SANTORA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:SHRINERS HOSPITALS FOR CHILDREN SALT
Mailing Address - Street 2:DEPT 5034
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-0001
Mailing Address - Country:US
Mailing Address - Phone:813-281-8478
Mailing Address - Fax:813-281-8113
Practice Address - Street 1:FAIRFAX ROAD AT VIRGINIA STREET
Practice Address - Street 2:SHRINERS HOSPITALS FOR CHILDREN
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-4399
Practice Address - Country:US
Practice Address - Phone:801-536-3600
Practice Address - Fax:801-536-3686
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2010-09-15
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Provider Licenses
StateLicense IDTaxonomies
UT173416-1205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91082008Medicaid
UTF09627Medicare UPIN