Provider Demographics
NPI:1679565071
Name:SANTOS, ERICK MANUEL (MD)
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:MANUEL
Last Name:SANTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2222 AIRLINE RD
Mailing Address - Street 2:STE B1
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2644
Mailing Address - Country:US
Mailing Address - Phone:361-561-3500
Mailing Address - Fax:361-561-3505
Practice Address - Street 1:2222 AIRLINE RD
Practice Address - Street 2:STE B1
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2644
Practice Address - Country:US
Practice Address - Phone:361-561-3500
Practice Address - Fax:361-561-3505
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK2998207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G70169Medicare UPIN
TX8F0754Medicare PIN