Provider Demographics
NPI:1831150630
Name:RAMOS, FABIAN ALONSO (MD)
Entity type:Individual
Prefix:DR
First Name:FABIAN
Middle Name:ALONSO
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 1:100 3RD AVE W
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8638
Mailing Address - Country:US
Mailing Address - Phone:941-708-9555
Mailing Address - Fax:941-708-5465
Practice Address - Street 1:100 3RD AVE W
Practice Address - Street 2:SUITE 110
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8638
Practice Address - Country:US
Practice Address - Phone:941-708-9555
Practice Address - Fax:941-708-5465
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71496208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43-1962888OtherTAX IDENTIFICATION NUMBER
FLME71496OtherMEDICAL LICENSE
FLH08542Medicare UPIN
FLME71496OtherMEDICAL LICENSE