Provider Demographics
NPI:1104141431
Name:ROMAN, DANIEL DAVID (PA-C)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:DAVID
Last Name:ROMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CS BN CO C MED C WAJDC0
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CAMP CASEY TMC
Practice Address - Street 2:
Practice Address - City:CAMP CASEY
Practice Address - State:KOREA
Practice Address - Zip Code:96224
Practice Address - Country:KR
Practice Address - Phone:210-478-9620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1091574363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant