Individual
JARED W SANTANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 250-4906
Mailing address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M-2076
GU
207R00000X
Internal Medicine Physician
N4722
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206158201
—
TX
05
—
206158202
—
TX
05
—
206158203
—
TX
Enumeration date
08/18/2009
Last updated
12/19/2023
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