MEDICARE: DR. MANUEL DE JESUS RAMIREZ BANQUERIS MD

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	208D00000X	General Practice Physician	21549	PR
2	208D00000X	General Practice Physician	ACN1202	FL

General Provider Information

NPI Number	:	1164070330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL DE JESUS RAMIREZ BANQUERIS MD

Provider Business Mailing Address
First Line	:	12171 SW 268TH ST
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33032-8001
Country	:	US
Telephone Number	:	305-278-0200
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E DR MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-3866
Country	:	US
Telephone Number	:	813-308-4040
Fax Number	:

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

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	10/25/2021

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