Individual
EDUARDO ERASTO SANTIAGO ONGKEKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4565
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4565
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD154449
OR
207Q00000X
Family Medicine Physician
MT192364
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
NBMC-MAIN GROUP NPI
OR
01
—
161133
NBMC-MAIN GROUP MEDICAID
OR
05
—
500635456
—
OR
01
—
93-0635514
NBMC-MAIN GROUP TAX ID FOR BILLING
OR
01
—
R0000WFBTV
NBMC-MAIN GROUP MEDICARE
OR
Enumeration date
10/23/2008
Last updated
07/26/2011
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