Provider Demographics
NPI:1063738524
Name:RAUL ROMERO, MD
Entity type:Organization
Organization Name:RAUL ROMERO, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:B
Authorized Official - Last Name:GODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-954-0897
Mailing Address - Street 1:26 E BASELINE RD STE 121
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6541
Mailing Address - Country:US
Mailing Address - Phone:602-243-3455
Mailing Address - Fax:602-343-3404
Practice Address - Street 1:26 E BASELINE RD STE 121
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6541
Practice Address - Country:US
Practice Address - Phone:602-243-3455
Practice Address - Fax:602-343-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC74515Medicare UPIN