Provider Demographics
NPI:1043443377
Name:RAMIREZ DOMINGUEZ, TATIANA (MD)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:RAMIREZ DOMINGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 7011B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8275
Mailing Address - Country:US
Mailing Address - Phone:314-251-6840
Mailing Address - Fax:314-251-7249
Practice Address - Street 1:621 S NEW BALLAS RD STE 7011B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8275
Practice Address - Country:US
Practice Address - Phone:314-251-6840
Practice Address - Fax:314-251-7249
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019007247208C00000X
MN54231208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN020003101Medicare PIN