Provider Demographics
NPI:1730158718
Name:RAMIREZ, ALFONSO (MD)
Entity type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:
Last Name:RAMIREZ
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 1:1121 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-5145
Mailing Address - Country:US
Mailing Address - Phone:214-943-5773
Mailing Address - Fax:214-948-3944
Practice Address - Street 1:1121 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5145
Practice Address - Country:US
Practice Address - Phone:214-943-5773
Practice Address - Fax:469-364-7978
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114491701Medicaid
75-2169593OtherUHC & OTHER INS ID
4553489OtherAETNA PROVIDER NO
TX00PL08OtherBCBS