Healthcare Provider Details

I. General information

NPI: 1245204155
Provider Name (Legal Business Name): ROLANDO YSADT RAMOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TWINING ST BLDG 760
MAXWELL AFB AL
36112-6027
US

IV. Provider business mailing address

300 TWINING ST BLDG 760
MAXWELL AFB AL
36112-6027
US

V. Phone/Fax

Practice location:
  • Phone: 334-953-6264
  • Fax:
Mailing address:
  • Phone: 334-953-6264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberMD425234
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME100496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: