Individual
FERNANDO LUIS GONZALEZ-RAMOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
77 HOSPITAL DRIVE, SUITE 101, LOGAN, WV 25601-3451
(304) 831-0450
(304) 831-0452
Mailing address
PO BOX 1933, HARVEY, LA 70059-1933
(787) 242-7464
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12651
PR
207R00000X
Internal Medicine Physician
21171
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001860338
BCBS
WV
05
—
3810011047
—
WV
01
—
438170
ADVANTRA FREEDOM
—
01
—
611399500
BLACK LUNG
—
01
—
7102000WV2560
BCBS OF MICHIGAN
—
01
—
DF2728
RR MEDICARE
WV
Enumeration date
06/27/2006
Last updated
11/05/2019
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