Basic Information
| Provider Information | |||||||||
| NPI: | 1548242399 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAMIREZ | ||||||||
| FirstName: | EDGAR | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1868 HIGHLAND OAKS BLVD STE B | ||||||||
| Address2: | |||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335597413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135742460 | ||||||||
| FaxNumber: | 8139495001 | ||||||||
| Practice Location | |||||||||
| Address1: | 2818 CYPRESS RIDGE BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | WESLEY CHAPEL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335446306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137125700 | ||||||||
| FaxNumber: | 8139719600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 06/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME82491 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0014X | ME82491 | FL | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 266315500 | 05 | FL | MEDICAID | P00613235 | 01 | FL | RR MEDICARE | OTHER |