Provider Demographics
NPI:1609815240
Name:RAMOS, ROQUE S (MD)
Entity Type:Individual
Prefix:
First Name:ROQUE
Middle Name:S
Last Name:RAMOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROQUE
Other - Middle Name:S
Other - Last Name:RAMOS OLIVARES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2023 BROOK HILL LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7944
Mailing Address - Country:US
Mailing Address - Phone:636-391-1706
Mailing Address - Fax:636-391-1201
Practice Address - Street 1:14897 CLAYTON RD
Practice Address - Street 2:STE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7887
Practice Address - Country:US
Practice Address - Phone:636-391-1706
Practice Address - Fax:636-391-1201
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100898207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089824Medicaid
ILP00447284OtherRR MEDICARE
ILK48835Medicare PIN
ILP00447284OtherRR MEDICARE
MO245050091Medicare PIN
MOMA1468001Medicare PIN
P00357506Medicare PIN
MO150050033Medicare PIN
MOF93178Medicare UPIN