Healthcare Provider Details

I. General information

NPI: 1801849831
Provider Name (Legal Business Name): JOSE A RAMIREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3844 S. LINDBERGH BLVD SUITE 160
ST .LOUIS MO
63127
US

IV. Provider business mailing address

3844 S LINDBERGH BLVD. SUITE 160
ST. LOUIS MO
63127
US

V. Phone/Fax

Practice location:
  • Phone: 314-698-2400
  • Fax: 314-822-0975
Mailing address:
  • Phone: 314-698-2400
  • Fax: 314-822-0975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number36680
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: