=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861613762
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JESUS M. RAMIREZ, MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2007
-----------------------------------------------------
Last Update Date | 06/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 621 MARTIN LUTHER KING JR BLVD
-----------------------------------------------------
City | PANAMA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32401-3642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-785-3212
-----------------------------------------------------
Fax | 850-785-3299
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 621 MARTIN LUTHER KING JR BLVD
-----------------------------------------------------
City | PANAMA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32401-3642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-785-3212
-----------------------------------------------------
Fax | 850-785-3299
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JESUS MARIA RAMIREZ I
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 850-785-3212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME0076412
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------