Provider Demographics
NPI:1912025503
Name:ROIS ROMERO, RICARDO A (MD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:A
Last Name:ROIS ROMERO
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 1:5462 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6569
Mailing Address - Country:US
Mailing Address - Phone:321-421-7122
Mailing Address - Fax:866-611-2535
Practice Address - Street 1:5462 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6569
Practice Address - Country:US
Practice Address - Phone:321-421-7122
Practice Address - Fax:866-611-2535
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMD110773207QG0300X
FLME110773208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFI376YOtherMEDICARE
FLP01380502OtherFL RR MEDICARE
FL004007200Medicaid
FLFI376ZMedicare PIN
WA0220985OtherLABOR & INDUSTRIES