Provider Demographics
NPI:1699795245
Name:SANTIAGO, FREDRIC A (MD)
Entity type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:A
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12729
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-2729
Mailing Address - Country:US
Mailing Address - Phone:409-899-3340
Mailing Address - Fax:409-899-3400
Practice Address - Street 1:3030 NORTH ST
Practice Address - Street 2:500
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1433
Practice Address - Country:US
Practice Address - Phone:409-899-3340
Practice Address - Fax:409-899-3400
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7650207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00020MMedicare ID - Type Unspecified
TXF02182Medicare UPIN