MEDICARE: SHELLEY BRUCE 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	207V00000X	Obstetrics & Gynecology Physician	K1760	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K1760	OTHER	TX	STATE LICENSE NUMBER
2	30106078	OTHER	TX	DPS NUMBER

General Provider Information

NPI Number	:	1982659942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY BRUCE RAMOS MD

Provider Business Mailing Address
First Line	:	701 TUSCAN DR
Second Line	:	SUITE 200
City	:	IRVING
State	:	TX
Zip	:	75039-4133
Country	:	US
Telephone Number	:	972-401-3200
Fax Number	:	972-401-3230

Provider Business Practice Location Address
First Line	:	701 TUSCAN DR
Second Line	:	SUITE 200
City	:	IRVING
State	:	TX
Zip	:	75039-4133
Country	:	US
Telephone Number	:	972-401-3200
Fax Number	:	972-401-3230

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	03/07/2023

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