Provider Demographics
NPI:1255480141
Name:RAMOS-RIVAS, EDID (MD)
Entity type:Individual
Prefix:
First Name:EDID
Middle Name:
Last Name:RAMOS-RIVAS
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 1:315 E PLEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3933
Mailing Address - Country:US
Mailing Address - Phone:972-228-4888
Mailing Address - Fax:
Practice Address - Street 1:315 E PLEASANT RUN RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3933
Practice Address - Country:US
Practice Address - Phone:972-228-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9291207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0964538-02Medicaid
00251JMedicare ID - Type Unspecified
TX0964538-02Medicaid