Provider Demographics
NPI:1215935176
Name:RAMIREZ, MAURICIO A (MD)
Entity type:Individual
Prefix:
First Name:MAURICIO
Middle Name:A
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1449
Mailing Address - Fax:239-424-1421
Practice Address - Street 1:13340 METRO PARKWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4703
Practice Address - Country:US
Practice Address - Phone:239-343-1448
Practice Address - Fax:239-343-1449
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90003207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269594400Medicaid
FL269594400Medicaid
FL269594400Medicaid