Provider Demographics
NPI:1598956641
Name:SROUFE, RAMESES L (MD)
Entity Type:Individual
Prefix:
First Name:RAMESES
Middle Name:L
Last Name:SROUFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6066 RIVER OAKS RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2547
Mailing Address - Country:US
Mailing Address - Phone:202-246-2582
Mailing Address - Fax:
Practice Address - Street 1:6066 RIVER OAKS RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2547
Practice Address - Country:US
Practice Address - Phone:202-246-2582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS221712085R0001X
TN490092085R0001X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1001023Medicaid