Provider Demographics
NPI:1548449093
Name:RAMOS, GUSTAVO (MD)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:RAMOS
Suffix:
Gender:M
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 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-8525
Mailing Address - Fax:956-362-8529
Practice Address - Street 1:1200 E SAVANNAH AVE STE 3
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1728
Practice Address - Country:US
Practice Address - Phone:956-362-8525
Practice Address - Fax:956-362-8529
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5989207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DQ71OtherBLUE CROSS BLUE SHIELD
TX110356602Medicaid
TX110356602Medicaid
TX00DQ71Medicare PIN