Provider Demographics
NPI:1902914815
Name:SANTOS, LEONOR (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONOR
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 CITRUS TOWER BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2756
Mailing Address - Country:US
Mailing Address - Phone:352-404-8840
Mailing Address - Fax:
Practice Address - Street 1:255 CITRUS TOWER BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2756
Practice Address - Country:US
Practice Address - Phone:352-404-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 77216207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F33760Medicare UPIN
FL58807Medicare ID - Type Unspecified