Basic Information
| Provider Information | |||||||||
| NPI: | 1982659942 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMOS | ||||||||
| FirstName: | SHELLEY | ||||||||
| MiddleName: | BRUCE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BRUCE | ||||||||
| OtherFirstName: | SHELLEY | ||||||||
| OtherMiddleName: | KATHRIN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 701 TUSCAN DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750394133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724013200 | ||||||||
| FaxNumber: | 9724013230 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 TUSCAN DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750394133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724013200 | ||||||||
| FaxNumber: | 9724013230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 07/21/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | K1760 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | K1760 | 01 | TX | STATE LICENSE NUMBER | OTHER | BR5784726 | 01 | TX | DEA NUMBER | OTHER | 30106078 | 01 | TX | DPS NUMBER | OTHER |