Provider Demographics
NPI:1306903422
Name:ROMAN EYXARCH, PEDRO C (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:C
Last Name:ROMAN EYXARCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1617
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-740-4465
Mailing Address - Fax:787-785-2680
Practice Address - Street 1:CARIMED PLAZA
Practice Address - Street 2:SUITE 309 CALLE SANTA CRUZ B1
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-740-4465
Practice Address - Fax:787-785-2680
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
060607OtherCRUZ AZUL
212102OtherPREFFERED HEALTH
89556OtherTRIPLE S
89556OtherTRIPLE S OPTIMO
1111981OtherACAA
2251OtherINTERNATIONAL MEDICAL CAR
89556OtherMEDICARE SELECTO
3106OtherPREFFERED MEDICARE CHOICE
G67993Medicare UPIN
2251OtherINTERNATIONAL MEDICAL CAR