Provider Demographics
NPI:1457380974
Name:RAMIREZ, MAURICE ANTHONY (DO PHD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:ANTHONY
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:DO PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 BEN HILL TRAIL
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33898
Mailing Address - Country:US
Mailing Address - Phone:407-301-3458
Mailing Address - Fax:407-348-2686
Practice Address - Street 1:4800 BEN HILL TRAIL
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33898
Practice Address - Country:US
Practice Address - Phone:407-301-3458
Practice Address - Fax:407-348-2686
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-06366207P00000X
FLOS6366207P00000X
FLOS-6366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379370200Medicaid
FL379370200Medicaid
FL80742VMedicare PIN
F45955Medicare UPIN