Provider Demographics
NPI:1679555072
Name:RAMEY, STEPHEN JON (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JON
Last Name:RAMEY
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 5237
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-5237
Mailing Address - Country:US
Mailing Address - Phone:318-798-4606
Mailing Address - Fax:318-798-4601
Practice Address - Street 1:1505 E BERT KOUNS INDUSTRIAL LOOP # 101
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5723
Practice Address - Country:US
Practice Address - Phone:318-573-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-19
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.0141992086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1322962Medicaid
LA5L627Medicare ID - Type UnspecifiedPLASTIC SURGERY
LAB61399Medicare UPIN