1306837554 NPI number — BETTY JEAN RAMOS-DOBRY PA-C

Table of content: BETTY JEAN RAMOS-DOBRY PA-C (NPI 1306837554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306837554 NPI number — BETTY JEAN RAMOS-DOBRY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMOS-DOBRY
Provider First Name:
BETTY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306837554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3110 NOGALITOS
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78225-2337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-533-0257
Provider Business Mailing Address Fax Number:
210-531-9488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3110 NOGALITOS
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78225-2337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-533-0257
Provider Business Practice Location Address Fax Number:
210-531-9488
Provider Enumeration Date:
11/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA03614 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11496106 . This is a "CAQH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 297775YS18 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: PA03614 . This is a "LICENSE PA-C" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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