Provider Demographics
NPI:1417927104
Name:LEMOS, RICARDO SOUZA
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:SOUZA
Last Name:LEMOS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:RICARDO
Other - Middle Name:SOUZA
Other - Last Name:LEMOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2801 E 29TH ST STE 123
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2699
Mailing Address - Country:US
Mailing Address - Phone:979-776-3850
Mailing Address - Fax:979-776-3890
Practice Address - Street 1:2801 E 29TH ST STE 123
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2699
Practice Address - Country:US
Practice Address - Phone:979-776-3850
Practice Address - Fax:979-776-3890
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6155207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0050HHOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX440003708OtherMEDICARE RAILROAD
TX043626302Medicaid
TXE16306Medicare UPIN
TX8122B0Medicare PIN