Provider Demographics
NPI:1225147135
Name:MONTALVO, RAMIRO A JR (MD)
Entity Type:Individual
Prefix:
First Name:RAMIRO
Middle Name:A
Last Name:MONTALVO
Suffix:JR
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 1:940 BROOKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2644
Mailing Address - Country:US
Mailing Address - Phone:601-823-5000
Mailing Address - Fax:601-823-4140
Practice Address - Street 1:940 BROOKWAY BLVD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2644
Practice Address - Country:US
Practice Address - Phone:601-823-5000
Practice Address - Fax:601-823-4140
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00110853Medicaid
MS110000829Medicare ID - Type Unspecified
MS00110853Medicaid