Provider Demographics
NPI:1063597912
Name:ROMERO, ALFRED THOMAS (MD)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:THOMAS
Last Name:ROMERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5000 US HIGHWAY 17
Mailing Address - Street 2:SUITE 18 #288
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8231
Mailing Address - Country:US
Mailing Address - Phone:386-326-1590
Mailing Address - Fax:386-326-1592
Practice Address - Street 1:6710 OLD WOLF BAY RD
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6830
Practice Address - Country:US
Practice Address - Phone:386-326-1590
Practice Address - Fax:386-326-1592
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60213207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23880OtherBCBS OF FLORIDA PROVIDER
FL23880OtherBCBS OF FLORIDA PROVIDER
F77036Medicare UPIN
P00200884Medicare ID - Type UnspecifiedRR MEDICARE PROVIDER NO.