Provider Demographics
NPI:1720414501
Name:LOPEZ-RAMOS, JORGE I (LSA)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:I
Last Name:LOPEZ-RAMOS
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 HIGH LANE CT
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-1897
Mailing Address - Country:US
Mailing Address - Phone:936-689-3367
Mailing Address - Fax:
Practice Address - Street 1:1007 HIGH LANE CT
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1897
Practice Address - Country:US
Practice Address - Phone:936-689-3367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00484363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical