Provider Demographics
NPI:1235407214
Name:RAMIREZ, JORGE (DO)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:311 BUDDY GANEM
Practice Address - Street 2:STE A
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-3233
Practice Address - Country:US
Practice Address - Phone:361-777-0500
Practice Address - Fax:361-777-0503
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8175207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1L5826OtherMEDICARE
TX342405301Medicaid
TXP02601798OtherMCRR