Provider Demographics
NPI:1679766315
Name:STEPHEN JON RAMEY MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:STEPHEN JON RAMEY MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JON
Authorized Official - Last Name:RAMEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-573-9896
Mailing Address - Street 1:3106 CENTENARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-4542
Mailing Address - Country:US
Mailing Address - Phone:318-573-9896
Mailing Address - Fax:
Practice Address - Street 1:7013 SAND BEACH BLVD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4929
Practice Address - Country:US
Practice Address - Phone:318-681-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014199208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1322962Medicaid
LA1322962Medicaid