Provider Demographics
NPI:1528061488
Name:NG, FEDERICO ROMAN (MD)
Entity type:Individual
Prefix:DR
First Name:FEDERICO
Middle Name:ROMAN
Last Name:NG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7922 EWING HALSELL DR
Mailing Address - Street 2:STE 270
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3725
Mailing Address - Country:US
Mailing Address - Phone:210-614-2828
Mailing Address - Fax:210-614-2558
Practice Address - Street 1:7922 EWING HALSELL DR
Practice Address - Street 2:STE 270
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3725
Practice Address - Country:US
Practice Address - Phone:210-614-2828
Practice Address - Fax:210-614-2558
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2011-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ6623208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131179706Medicaid
TX131179706Medicaid