Provider Demographics
NPI:1104928423
Name:ROMAN, ERNESTO J (MD)
Entity type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:J
Last Name:ROMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:425 CARR 693
Mailing Address - Street 2:PMB 137
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4802
Mailing Address - Country:US
Mailing Address - Phone:787-270-6082
Mailing Address - Fax:787-855-0285
Practice Address - Street 1:CARR. #2, KM 40.2 , PLAZA JARDINES
Practice Address - Street 2:SUITE # 3
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-855-0411
Practice Address - Fax:787-855-0285
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PR13768208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-38184Medicare UPIN
PR23256Medicare ID - Type Unspecified