Provider Demographics
NPI:1053415646
Name:SANTILLAN, CARLOS HUMBERTO (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:HUMBERTO
Last Name:SANTILLAN
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 1:7300 LYNNLEE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-1807
Mailing Address - Country:US
Mailing Address - Phone:806-353-7860
Mailing Address - Fax:806-359-5217
Practice Address - Street 1:5920 AMARILLO BLVD W
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4148
Practice Address - Country:US
Practice Address - Phone:806-353-9181
Practice Address - Fax:806-359-5217
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4932207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0000W9666Medicaid
85891BMedicare ID - Type Unspecified
NM0000W9666Medicaid