Provider Demographics
NPI:1427016476
Name:CAVAZOS, RAMIRO D (MD)
Entity Type:Individual
Prefix:
First Name:RAMIRO
Middle Name:D
Last Name:CAVAZOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAMIRO
Other - Middle Name:D
Other - Last Name:CAVAZOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1108 S HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4430
Mailing Address - Country:US
Mailing Address - Phone:817-335-3255
Mailing Address - Fax:817-338-9563
Practice Address - Street 1:1108 S HENDERSON ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4430
Practice Address - Country:US
Practice Address - Phone:817-335-3255
Practice Address - Fax:817-338-9563
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9388208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127096903Medicaid
TX10028699OtherAMERIGROUP
TX130900703OtherMEDICAID EPSDT
TX83214XOtherBCBS
TX4229409OtherAETNA
TX127096903Medicaid