MEDICARE: FERNANDO LUIS GONZALEZ-RAMOS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	21171	WV
2	207R00000X	Internal Medicine Physician	12651	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DF2728	OTHER	WV	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	611399500	OTHER		BLACK LUNG
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	438170	OTHER		ADVANTRA FREEDOM
5	438170	OTHER		COVENTRY HEALTH
6	001860338	OTHER	WV	BCBS
7	7102000WV2560	OTHER		BCBS OF MICHIGAN

General Provider Information

NPI Number	:	1053348771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO LUIS GONZALEZ-RAMOS MD

Provider Business Mailing Address
First Line	:	PO BOX 1933
Second Line	:
City	:	HARVEY
State	:	LA
Zip	:	70059-1933
Country	:	US
Telephone Number	:	787-242-7464
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 HOSPITAL DRIVE
Second Line	:	SUITE 101
City	:	LOGAN
State	:	WV
Zip	:	25601-3451
Country	:	US
Telephone Number	:	304-831-0450
Fax Number	:	304-831-0452

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	11/05/2019

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Directions to “ FERNANDO LUIS GONZALEZ-RAMOS MD” Practice Location

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