Provider Demographics
NPI:1205868262
Name:AMOR, ANTONIO RAGAY (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:RAGAY
Last Name:AMOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3559 E SOUTH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4519
Mailing Address - Country:US
Mailing Address - Phone:704-366-7584
Mailing Address - Fax:704-364-2417
Practice Address - Street 1:3559 E SOUTH ST STE B
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4519
Practice Address - Country:US
Practice Address - Phone:704-366-7584
Practice Address - Fax:704-364-2417
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891292VMedicaid
NC1292VOtherBLUE CROSS BLUE SHIELD
NC2293758EMedicare PIN
G03207Medicare UPIN
NC891292VMedicaid