Provider Demographics
NPI:1891801528
Name:RODRIGUEZ-RAMOS, JUAN L (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:L
Last Name:RODRIGUEZ-RAMOS
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:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-421-4489
Practice Address - Street 1:1620 MULKEY RD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1171
Practice Address - Country:US
Practice Address - Phone:770-948-3774
Practice Address - Fax:770-739-9609
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1323207K00000X
GA95169207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173029301Medicaid
TX173029302Medicaid
TX8D5473Medicare PIN
TX173029301Medicaid
TX8L26581Medicare PIN
TXP00824130Medicare PIN