1356304281 NPI number — DR. RAMIRO LEAL MD

Table of content: DR. RAMIRO LEAL MD (NPI 1356304281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356304281 NPI number — DR. RAMIRO LEAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEAL
Provider First Name:
RAMIRO
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
LEAL
Provider Other First Name:
RAMIRO
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
F.A.C.O.G.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1356304281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 S JACKSON RD
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78503-1588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-971-9930
Provider Business Mailing Address Fax Number:
956-971-9934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 S. JACKSON ROAD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-971-9930
Provider Business Practice Location Address Fax Number:
956-971-9934
Provider Enumeration Date:
04/11/2006

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: 207V00000X , with the licence number:  L2979 , 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: 8A5350 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 147380304 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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