Provider Demographics
NPI:1003886979
Name:RAMIREZ, ROQUE JOEL (MD, FICS)
Entity Type:Individual
Prefix:DR
First Name:ROQUE
Middle Name:JOEL
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:MD, FICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5752 SANTA CLARA DR
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380-9403
Mailing Address - Country:US
Mailing Address - Phone:361-813-8120
Mailing Address - Fax:361-232-5164
Practice Address - Street 1:5752 SANTA CLARA DR
Practice Address - Street 2:
Practice Address - City:ROBSTOWN
Practice Address - State:TX
Practice Address - Zip Code:78380-9403
Practice Address - Country:US
Practice Address - Phone:361-813-8120
Practice Address - Fax:361-232-5164
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4201208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74-2976976OtherTAX ID
TX0800419-01Medicaid
TXH28818Medicare UPIN
TX74-2976976OtherTAX ID