Provider Demographics
NPI:1184095655
Name:RAMSEY, JEROME
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:RAMSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 100338 BOX NUMBER 1 FPO AE 96693
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92136-0001
Mailing Address - Country:US
Mailing Address - Phone:219-680-6081
Mailing Address - Fax:
Practice Address - Street 1:2534 TRIDENT WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5493
Practice Address - Country:US
Practice Address - Phone:619-437-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman