Healthcare Provider Details

I. General information

NPI: 1508818311
Provider Name (Legal Business Name): RAMON JONGO AQUINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 DOVER RD
CLARKSVILLE TN
37042-4144
US

IV. Provider business mailing address

351 DOVER RD
CLARKSVILLE TN
37042-4144
US

V. Phone/Fax

Practice location:
  • Phone: 931-552-4495
  • Fax: 931-552-1944
Mailing address:
  • Phone: 931-552-4495
  • Fax: 931-552-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD 15005
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: