Provider Demographics
NPI:1780815258
Name:BARRANTES RAMIREZ, THELMO FIDEL ERNESTO (MD)
Entity type:Individual
Prefix:DR
First Name:THELMO FIDEL
Middle Name:ERNESTO
Last Name:BARRANTES RAMIREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FIDEL
Other - Middle Name:
Other - Last Name:BARRANTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3821 MASTHEAD ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4679
Mailing Address - Country:US
Mailing Address - Phone:505-998-7400
Mailing Address - Fax:505-998-7741
Practice Address - Street 1:3821 MASTHEAD ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4679
Practice Address - Country:US
Practice Address - Phone:505-998-7400
Practice Address - Fax:505-998-7741
Is Sole Proprietor?:No
Enumeration Date:2009-08-01
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0696207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM93802072Medicaid
NMNMAAA0654Medicare PIN