Provider Demographics
NPI:1053348771
Name:GONZALEZ-RAMOS, FERNANDO LUIS (MD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:LUIS
Last Name:GONZALEZ-RAMOS
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:PO BOX 1933
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70059-1933
Mailing Address - Country:US
Mailing Address - Phone:787-242-7464
Mailing Address - Fax:
Practice Address - Street 1:77 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3451
Practice Address - Country:US
Practice Address - Phone:304-831-0450
Practice Address - Fax:304-831-0452
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21171207R00000X
PR12651207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
611399500OtherBLACK LUNG
WV3810011047Medicaid
438170OtherADVANTRA FREEDOM
WVDF2728OtherRR MEDICARE
438170OtherCOVENTRY HEALTH
WV001860338OtherBCBS
7102000WV2560OtherBCBS OF MICHIGAN
WVDF2728OtherRR MEDICARE
H81528Medicare UPIN