Individual
DR. RAMIRO ICAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1008 N MAIN ST, SIKESTON, MO 63801
(573) 472-6001
(573) 472-6006
Mailing address
430 WEST INDEPENDENCE STREET, JACKSON, MO 63755
(573) 243-0750
(813) 891-9066
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MDR7D79
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000094200
MEDICARE ID KIES PERSONAL
MO
05
—
202995807
—
MO
Enumeration date
08/31/2006
Last updated
08/14/2018
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