Provider Demographics
NPI:1104893817
Name:ROMAN, KIMBERLY WAYNETTE (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:WAYNETTE
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1924C DAUPHIN ISLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36605-3004
Mailing Address - Country:US
Mailing Address - Phone:251-476-5733
Mailing Address - Fax:251-470-7249
Practice Address - Street 1:1924C DAUPHIN ISLAND PKWY
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36605-3004
Practice Address - Country:US
Practice Address - Phone:251-476-5733
Practice Address - Fax:251-470-7249
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.38543207Q00000X
AL38543207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL239328Medicaid