Provider Demographics
NPI:1720063290
Name:RAMIREZ, ANGELIQUE M (MD)
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:M
Last Name:RAMIREZ
Suffix:
Gender:F
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3310 LIVE OAK ST
Practice Address - Street 2:COPC ADMINISTRATION
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6153
Practice Address - Country:US
Practice Address - Phone:214-590-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139127804Medicaid
TX139127808Medicaid
TX139127814Medicaid
TX139127803Medicaid
TX139127813Medicaid
TX139127812Medicaid
TX139127802Medicaid
TX139127810Medicaid
TX139127805Medicaid
TX139127807Medicaid
TX139127806Medicaid
TX139127809Medicaid
TX139127812Medicaid
TX139127808Medicaid