Provider Demographics
NPI:1902827868
Name:JEREZA, RAMON C (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:C
Last Name:JEREZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RALEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-5944
Mailing Address - Country:US
Mailing Address - Phone:304-252-8541
Mailing Address - Fax:304-253-2507
Practice Address - Street 1:200 RALEIGH AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-5944
Practice Address - Country:US
Practice Address - Phone:304-252-8541
Practice Address - Fax:304-253-2507
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09488207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0076323000Medicaid
WVD49148Medicare UPIN
WV0076323000Medicaid