Basic Information
| Provider Information | |||||||||
| NPI: | 1881952067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAMOS | ||||||||
| FirstName: | TREVY | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 E. 54TH AVE. | ||||||||
| Address2: | APT. 202A | ||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2195452128 | ||||||||
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| Practice Location | |||||||||
| Address1: | 325 N STATE OF FRANKLIN RD FL 3 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234397201 | ||||||||
| FaxNumber: | 4234397219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2012 | ||||||||
| LastUpdateDate: | 11/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4091 | TN | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.