Provider Demographics
NPI:1639108707
Name:DE LA GUERRA, RAMIRO A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMIRO
Middle Name:A
Last Name:DE LA GUERRA
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 1:104 PRIVATE PL
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-2147
Mailing Address - Country:US
Mailing Address - Phone:561-963-9811
Mailing Address - Fax:
Practice Address - Street 1:2201 45TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2047
Practice Address - Country:US
Practice Address - Phone:561-842-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67206207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251896100Medicaid
G06525Medicare UPIN
FL251896100Medicaid