Provider Demographics
NPI:1861613762
Name:JESUS M. RAMIREZ, MD PA
Entity type:Organization
Organization Name:JESUS M. RAMIREZ, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:850-785-3212
Mailing Address - Street 1:621 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3642
Mailing Address - Country:US
Mailing Address - Phone:850-785-3212
Mailing Address - Fax:850-785-3299
Practice Address - Street 1:621 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3642
Practice Address - Country:US
Practice Address - Phone:850-785-3212
Practice Address - Fax:850-785-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1200X
FLME0076412174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256061500Medicaid
FL46212XMedicare ID - Type Unspecified
FL256061500Medicaid