Provider Demographics
NPI:1558314294
Name:SANTOS, EMILIO (MD)
Entity type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:
Last Name:SANTOS
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 1:330 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4443
Mailing Address - Country:US
Mailing Address - Phone:689-230-8738
Mailing Address - Fax:
Practice Address - Street 1:330 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4443
Practice Address - Country:US
Practice Address - Phone:888-348-7363
Practice Address - Fax:888-348-7363
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN339208D00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014200100Medicaid
FLACN339OtherLICENSE