Provider Demographics
NPI:1265458517
Name:GARCIAREYES, RAMIRO
Entity Type:Individual
Prefix:DR
First Name:RAMIRO
Middle Name:
Last Name:GARCIAREYES
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RAMIRO
Other - Middle Name:REYES
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1669
Mailing Address - Street 2:1896 E BABBIT LANE
Mailing Address - City:SAN LUIS
Mailing Address - State:AZ
Mailing Address - Zip Code:85349-1669
Mailing Address - Country:US
Mailing Address - Phone:928-722-6112
Mailing Address - Fax:
Practice Address - Street 1:1896 EAST BABBIT LANE
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85349-1669
Practice Address - Country:US
Practice Address - Phone:928-722-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11867207Q00000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ651170616OtherTAX ID
AZ214057Medicaid
AZ214057Medicaid