Provider Demographics
NPI:1962697987
Name:PERRY M. SANTOS MD
Entity type:Organization
Organization Name:PERRY M. SANTOS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:VOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-946-5563
Mailing Address - Street 1:3435 NW 56TH ST
Mailing Address - Street 2:BLDG A, SUITE 412
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4448
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3435 NW 56TH ST
Practice Address - Street 2:BLDG A, SUITE 412
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4448
Practice Address - Country:US
Practice Address - Phone:405-946-5563
Practice Address - Fax:405-947-6626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20098207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK800522356Medicare PIN