Provider Demographics
NPI:1982963740
Name:RAMIREZ, AGUSTIN ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:AGUSTIN
Middle Name:ALBERTO
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2916 PEACH BLOSSOM DR
Mailing Address - Street 2:STE 101
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-8380
Mailing Address - Country:US
Mailing Address - Phone:502-432-9987
Mailing Address - Fax:
Practice Address - Street 1:2916 PEACH BLOSSOM DR STE 101
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-8380
Practice Address - Country:US
Practice Address - Phone:812-590-1600
Practice Address - Fax:812-590-6561
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY48319207Q00000X
IN01076087A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201092900Medicaid
KY7100373060Medicaid
IN201092900Medicaid
KYK134352Medicare PIN