Provider Demographics
NPI:1568420289
Name:RAMPERTAB, DEO (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEO
Middle Name:
Last Name:RAMPERTAB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 W PEORIA AVE
Mailing Address - Street 2:SUITE D805
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4608
Mailing Address - Country:US
Mailing Address - Phone:602-843-8585
Mailing Address - Fax:602-843-3664
Practice Address - Street 1:3201 W PEORIA AVE
Practice Address - Street 2:SUITE D805
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4608
Practice Address - Country:US
Practice Address - Phone:602-843-8585
Practice Address - Fax:602-843-3664
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0411213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z22274Medicare ID - Type Unspecified
AZU50631Medicare UPIN