1497957575 NPI number — ESTEBAN L. BONFANTE RAMIREZ MD

Table of content: (NPI 1508805979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497957575 NPI number — ESTEBAN L. BONFANTE RAMIREZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONFANTE RAMIREZ
Provider First Name:
ESTEBAN
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1497957575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10140 CENTURION PKWY N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32256-0532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-697-4127
Provider Business Mailing Address Fax Number:
904-697-5102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3183 PIPER STREET
Provider Second Line Business Practice Location Address:
STE S220
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-212-2240
Provider Business Practice Location Address Fax Number:
907-212-2872
Provider Enumeration Date:
06/01/2007

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: 207RG0100X , with the licence number:  ME134767 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0206X , with the licence number: 225872 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0206X , with the licence number: 28127 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0206X , with the licence number: ME134767 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0206X , with the licence number: 4301513015 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 009910442 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 279116100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023485000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03288866 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51542354 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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