Healthcare Provider Details

I. General information

NPI: 1639373210
Provider Name (Legal Business Name): MARK ADAM RAMIREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3162 APPALOOSA CIR
SAN ANGELO TX
76901-5225
US

IV. Provider business mailing address

PO BOX 62701
SAN ANGELO TX
76906-2701
US

V. Phone/Fax

Practice location:
  • Phone: 325-224-5981
  • Fax: 325-224-5981
Mailing address:
  • Phone: 325-224-5981
  • Fax: 325-224-5981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberM7551
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: