MEDICARE: MR. JORGE RODRIGUEZ RAMIREZ SAOO221

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	363AS0400X	Surgical Physician Assistant	SA00221	TX

General Provider Information

NPI Number	:	1336218494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JORGE RODRIGUEZ RAMIREZ SAOO221

Provider Business Mailing Address
First Line	:	1319 COPPERMEADE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77067-3503
Country	:	US
Telephone Number	:	713-530-0649
Fax Number	:	281-873-8563

Provider Business Practice Location Address
First Line	:	1319 COPPERMEADE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77067-3503
Country	:	US
Telephone Number	:	713-530-0649
Fax Number	:	281-873-8563

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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