Provider Demographics
NPI:1477657252
Name:YEPEZ, RAMIRO D (DPM, LLC)
Entity Type:Individual
Prefix:DR
First Name:RAMIRO
Middle Name:D
Last Name:YEPEZ
Suffix:
Gender:M
Credentials:DPM, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2224
Mailing Address - Country:US
Mailing Address - Phone:732-771-7580
Mailing Address - Fax:
Practice Address - Street 1:88 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1802
Practice Address - Country:US
Practice Address - Phone:973-344-4415
Practice Address - Fax:973-344-5224
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00283400213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0093505Medicaid
NJ0093505Medicaid
NJ093425DULMedicare PIN