Healthcare Provider Details

I. General information

NPI: 1679766315
Provider Name (Legal Business Name): STEPHEN JON RAMEY MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7013 SAND BEACH BLVD
SHREVEPORT LA
71105-4929
US

IV. Provider business mailing address

3106 CENTENARY BLVD
SHREVEPORT LA
71104-4542
US

V. Phone/Fax

Practice location:
  • Phone: 318-681-5050
  • Fax:
Mailing address:
  • Phone: 318-573-9896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number014199
License Number StateLA

VIII. Authorized Official

Name: STEPHEN JON RAMEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 318-573-9896