Individual
MARIBEL COLON-SANTIAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1515 NE LAWRIE TATUM RD, LAWTON, OK 73507-3002
(580) 354-5270
(580) 354-5289
Mailing address
2112 NW 55TH ST, LAWTON, OK 73505-3118
(580) 248-0972
(580) 248-0972
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
10773
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83073
MEDICARE PROVIDER NUMBER
PR
Enumeration date
08/31/2006
Last updated
10/27/2011
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