Provider Demographics
NPI:1487774311
Name:CHAVEZ-RAMONES, OMAR RICARDO (MD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:RICARDO
Last Name:CHAVEZ-RAMONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8954
Mailing Address - Country:US
Mailing Address - Phone:423-771-7205
Mailing Address - Fax:
Practice Address - Street 1:9220 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8954
Practice Address - Country:US
Practice Address - Phone:423-771-7205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR43816207P00000X
TN43816207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1526299Medicaid
TN103I119656Medicare PIN
0787207Medicare Oscar/Certification