Provider Demographics
NPI:1215902101
Name:PLURAD, SANTIAGO BO (DO)
Entity type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:BO
Last Name:PLURAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3915 WATSON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-1251
Mailing Address - Country:US
Mailing Address - Phone:314-781-7415
Mailing Address - Fax:314-644-4592
Practice Address - Street 1:3915 WATSON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1251
Practice Address - Country:US
Practice Address - Phone:314-781-7415
Practice Address - Fax:314-644-4592
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR3J49208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F05718Medicare UPIN