Basic Information
Provider Information
NPI: 1174550354
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAMSEY
FirstName: MARK
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 538 NE 7TH AVE
Address2: #2
City: FT LAUDERDALE
State: FL
PostalCode: 333011227
CountryCode: US
TelephoneNumber: 5612891842
FaxNumber:  
Practice Location
Address1: 1117 E HALLANDALE BEACH BLVD
Address2:  
City: HALLANDALE BEACH
State: FL
PostalCode: 330094488
CountryCode: US
TelephoneNumber: 9544546300
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/26/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XME76559FLY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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