Provider Demographics
NPI:1841686987
Name:RAMIREZ, MARY (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10630 BRAUN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2734
Mailing Address - Country:US
Mailing Address - Phone:210-838-2909
Mailing Address - Fax:210-905-0121
Practice Address - Street 1:10630 BRAUN RD STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-2734
Practice Address - Country:US
Practice Address - Phone:210-838-2909
Practice Address - Fax:210-905-0121
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1238207N00000X, 207N00000X
NM390200000X
NMRS2015-0317390200000X
NC219456390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4531139-01Medicaid