Provider Demographics
NPI:1457337552
Name:RAMOS, IVAN A (MD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:A
Last Name:RAMOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:STE 305
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:11910 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-1013
Practice Address - Country:US
Practice Address - Phone:727-863-2655
Practice Address - Fax:727-861-3435
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0046789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041733500Medicaid
K0068Medicare ID - Type Unspecified
FL041733500Medicaid