Provider Demographics
NPI:1568476521
Name:IVAN A RAMOS, MD, PA
Entity Type:Organization
Organization Name:IVAN A RAMOS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-863-2655
Mailing Address - Street 1:11910 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-1013
Mailing Address - Country:US
Mailing Address - Phone:727-863-2655
Mailing Address - Fax:727-863-7865
Practice Address - Street 1:11910 LITTLE RD.
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-1013
Practice Address - Country:US
Practice Address - Phone:727-863-2655
Practice Address - Fax:727-863-7865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041733500Medicaid
FLK0068Medicare ID - Type Unspecified
FL041733500Medicaid