Provider Demographics
NPI:1104873983
Name:RICARDO S. LEMOS MD PA
Entity type:Organization
Organization Name:RICARDO S. LEMOS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:SOUZA
Authorized Official - Last Name:LEMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-776-3850
Mailing Address - Street 1:2716 OSLER BLVD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2517
Mailing Address - Country:US
Mailing Address - Phone:979-776-3850
Mailing Address - Fax:979-776-3890
Practice Address - Street 1:2716 OSLER BLVD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2517
Practice Address - Country:US
Practice Address - Phone:979-776-3850
Practice Address - Fax:979-776-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6155261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0050HHOtherBLUE CROSS/BLUE SHIELD
TX148831402Medicaid
E16306Medicare UPIN
TX00051TMedicare ID - Type UnspecifiedGROUP NUMBER