Provider Demographics
NPI:1447253026
Name:SANTANA, VICTOR M (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:M
Last Name:SANTANA
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 1:262 DANNY THOMAS PL
Mailing Address - Street 2:MS 515
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-3006
Mailing Address - Fax:901-595-3842
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-3006
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN155542080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0528083Medicaid
ME422400000Medicaid
NC7612396Medicaid
AL009912950Medicaid
AR132328001Medicaid
TN3808805Medicaid
MS00118064Medicaid
MI104802061Medicaid
LA1533874Medicaid
IN200179620AMedicaid
MO205030703Medicaid
SCQ15554Medicaid
KS200380790AMedicaid
KY64927387Medicaid
CO09875328Medicaid
OK100220890AMedicaid
OH2025249Medicaid
AZ845167Medicaid
MO205030703Medicaid