Provider Demographics
NPI:1962567883
Name:DUARTE, RAMON ROSA (MD)
Entity type:Individual
Prefix:
First Name:RAMON
Middle Name:ROSA
Last Name:DUARTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAMON
Other - Middle Name:ROSA
Other - Last Name:DUARTE-AFARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4201 CENTRAL AVE NW
Mailing Address - Street 2:SUITE K-2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-1630
Mailing Address - Country:US
Mailing Address - Phone:505-639-5438
Mailing Address - Fax:505-544-2624
Practice Address - Street 1:4201 CENTRAL AVE NW
Practice Address - Street 2:SUITE K-2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-1630
Practice Address - Country:US
Practice Address - Phone:505-639-5438
Practice Address - Fax:505-544-2624
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM79-158207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ1152Medicaid
NM348530702Medicare ID - Type Unspecified
NMZ1152Medicaid