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General NPI Number Information
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NPI Number | 1558568253
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Entity Type | Individual
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Provider Name | MATTHEW HAWTHORNE RAMAGE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 3510 RICHMOND RD STE 100
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City | TEXARKANA
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State | TX
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Zip | 75503-0712
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Country | US
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Telephone | 903-614-5220
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 846098
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City | DALLAS
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State | TX
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Zip | 75284-6098
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Country | US
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Telephone | 903-606-6400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | S7764
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License Number State | TX
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