Provider Demographics
NPI:1467498774
Name:RAMIRO, MARK ANTHONY G (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK ANTHONY
Middle Name:G
Last Name:RAMIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:A
Other - Last Name:RAMIRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1400 CLAUD RD
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-8622
Mailing Address - Country:US
Mailing Address - Phone:870-247-9499
Mailing Address - Fax:870-247-5312
Practice Address - Street 1:1400 CLAUD RD
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-8622
Practice Address - Country:US
Practice Address - Phone:870-247-9499
Practice Address - Fax:870-247-5312
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-2876207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142621001Medicaid
AR5L815Medicare ID - Type Unspecified
AR142621001Medicaid