Provider Demographics
NPI:1861474595
Name:TY, RAMON C JR (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:C
Last Name:TY
Suffix:JR
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7737 SOUTHWEST FWY
Mailing Address - Street 2:#565
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1807
Mailing Address - Country:US
Mailing Address - Phone:713-779-3789
Mailing Address - Fax:713-779-6789
Practice Address - Street 1:7737 SOUTHWEST FWY
Practice Address - Street 2:#565
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1807
Practice Address - Country:US
Practice Address - Phone:713-779-3789
Practice Address - Fax:713-779-6789
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113946104Medicaid
TX113946104Medicaid
TXB27151Medicare UPIN