Basic Information
| Provider Information | |||||||||
| NPI: | 1740307354 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANTOS-FLORES | ||||||||
| FirstName: | BYRON | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SANTOS | ||||||||
| OtherFirstName: | BYRON | ||||||||
| OtherMiddleName: | A | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12990 MANCHESTER RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | DES PERES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631311860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149090633 | ||||||||
| FaxNumber: | 3149090391 | ||||||||
| Practice Location | |||||||||
| Address1: | 12990 MANCHESTER RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | DES PERES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631311860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149090633 | ||||||||
| FaxNumber: | 3149090391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 09/08/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | R9F62 | MO | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 180013399 | 01 | MEDICARE RAILROAD | OTHER | 202336707 | 05 | MO | MEDICAID | 4400520 | 01 | AETNA | OTHER | 12458 | 01 | OPTICARE | OTHER | 0800111 | 01 | UNITED HEALTHCARE | OTHER | 24308 | 01 | MO | ANTHEM BCBS | OTHER | 008248 | 01 | MO | EXCLUSIVE CHOICE | OTHER | 105378 | 01 | HEALTHLINK | OTHER | 48680 | 01 | MO | CMR INSURANCE PLAN | OTHER |