Provider Demographics
NPI:1730166505
Name:RAMOS, RUSTICO A (MD)
Entity type:Individual
Prefix:DR
First Name:RUSTICO
Middle Name:A
Last Name:RAMOS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:515 MAPLE VALLEY DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1919
Practice Address - Country:US
Practice Address - Phone:573-760-7920
Practice Address - Fax:573-756-9597
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2021-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2000146139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1730166505Medicaid
MO1730166505Medicaid
MO132470118Medicare PIN
MOH12933Medicare UPIN
MO000094742Medicare PIN