Provider Demographics
NPI:1306025150
Name:RAMIREZ, ROGELIO SERGIO (MD)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:SERGIO
Last Name:RAMIREZ
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 1:210 S BRYAN RD
Mailing Address - Street 2:SUITE 5 A
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6204
Mailing Address - Country:US
Mailing Address - Phone:956-585-6611
Mailing Address - Fax:956-585-1822
Practice Address - Street 1:210 S BRYAN RD
Practice Address - Street 2:SUITE 5 A
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6204
Practice Address - Country:US
Practice Address - Phone:956-585-6611
Practice Address - Fax:956-585-1822
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1828208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137317704Medicaid
TX137317706Medicaid
TXE888555Medicare UPIN