Provider Demographics
NPI:1497957575
Name:BONFANTE RAMIREZ, ESTEBAN L (MD)
Entity type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:L
Last Name:BONFANTE RAMIREZ
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 1:10140 CENTURION PKWY N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0532
Mailing Address - Country:US
Mailing Address - Phone:904-697-4127
Mailing Address - Fax:904-697-5102
Practice Address - Street 1:3183 PIPER STREET
Practice Address - Street 2:STE S220
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-212-2240
Practice Address - Fax:907-212-2872
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134767207RG0100X, 2080P0206X
AK2258722080P0206X
AL281272080P0206X
MI43015130152080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910442Medicaid
FL279116100Medicaid
FL023485000Medicaid
MS03288866Medicaid
AL51542354OtherBCBS