Provider Demographics
NPI:1528055258
Name:ROMAN, JUAN C (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:ROMAN
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 1:500 S UNIVERSITY AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5304
Mailing Address - Country:US
Mailing Address - Phone:501-476-3914
Mailing Address - Fax:
Practice Address - Street 1:500 S UNIVERSITY AVE STE 214
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5304
Practice Address - Country:US
Practice Address - Phone:501-476-3914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1764207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR050060897OtherRAILROAD MEDICARE (LRPM)
AR171973300OtherUS DEPT. OF LABOR OWCP
AR1792000020OtherQUAL CHOICE (LRPM)
AR172478000OtherUS DOL OWCP (LRPM)
AR050060898OtherRAILROAD MEDICARE
AR71033532430OtherQUAL CHOICE
AR5K805OtherBLUE CROSS BLUE SHIELD
ARS01847OtherNOVASYS
AR134483001Medicaid
AR770132401OtherARKANSAS BREASTCARE
AR770132401OtherARKANSAS BREASTCARE