Provider Demographics
NPI:1043628712
Name:LERMA, RICARDO JR (PA-C)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:LERMA
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 WEST 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570
Mailing Address - Country:US
Mailing Address - Phone:956-565-6373
Mailing Address - Fax:956-565-6177
Practice Address - Street 1:801 WEST 2ND STREET
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570
Practice Address - Country:US
Practice Address - Phone:956-565-6373
Practice Address - Fax:956-565-6177
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05833363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant