Provider Demographics
NPI:1609971423
Name:GARCIA RAMOS, GUSTAVO ADOLFO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:ADOLFO
Last Name:GARCIA RAMOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GUSTAVO
Other - Middle Name:ADOLFO
Other - Last Name:GARCIA RAMOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1804 WHITEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045
Mailing Address - Country:US
Mailing Address - Phone:956-795-0760
Mailing Address - Fax:
Practice Address - Street 1:6551 STAR CT
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-523-7850
Practice Address - Fax:956-523-7851
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000141G1Medicaid
TXP000141G1Medicaid
TX00141GMedicare PIN