Provider Demographics
NPI:1063409076
Name:RAMIREZ, ANTONIO J (DO)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:J
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WEST BASS STREET
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-6625
Mailing Address - Country:US
Mailing Address - Phone:407-846-3166
Mailing Address - Fax:407-846-0019
Practice Address - Street 1:320 WEST BASS STREET
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-6625
Practice Address - Country:US
Practice Address - Phone:407-846-3166
Practice Address - Fax:407-846-0019
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS0006118208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377929700Medicaid
FLG14679Medicare UPIN
FL377929700Medicaid