MEDICARE: CORAZON MEDINA RAMIREZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	G2189	TX

General Provider Information

NPI Number	:	1003869223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORAZON MEDINA RAMIREZ M.D.

Provider Business Mailing Address
First Line	:	9080 HARRY HINES BLVD
Second Line	:	STE 110
City	:	DALLAS
State	:	TX
Zip	:	75235-1720
Country	:	US
Telephone Number	:	817-516-8811
Fax Number	:	817-516-8444

Provider Business Practice Location Address
First Line	:	9080 HARRY HINES BLVD
Second Line	:	STE 110
City	:	DALLAS
State	:	TX
Zip	:	75235-1720
Country	:	US
Telephone Number	:	817-516-8811
Fax Number	:	817-516-8444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/08/2007

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