Provider Demographics
NPI:1922046622
Name:RAMOS, LOUIS EALDAMA (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:EALDAMA
Last Name: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 1:2604 THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1641
Mailing Address - Country:US
Mailing Address - Phone:512-640-2691
Mailing Address - Fax:
Practice Address - Street 1:1201 W 38TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1006
Practice Address - Country:US
Practice Address - Phone:512-640-2691
Practice Address - Fax:512-598-8699
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041144207R00000X
TXL2580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341978003Medicaid
TX341978005Medicaid
TX341978004Medicaid
TX341978002Medicaid
WA9854RAOtherBSWA
WA8312860Medicaid
TX341978001Medicaid
WA9854RAOtherBSWA
WAG8851171Medicare PIN
TX341978004Medicaid
TX341978003Medicaid
TX341978001Medicaid
WAGAB34238Medicare PIN
TX341978005Medicaid
TX341978002Medicaid
TX366072YRG5Medicare PIN