1861456550 NPI number — DR. HENRY J. LOPEZ-ROMAN MD

Table of content: DR. HENRY J. LOPEZ-ROMAN MD (NPI 1861456550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861456550 NPI number — DR. HENRY J. LOPEZ-ROMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ-ROMAN
Provider First Name:
HENRY
Provider Middle Name:
J.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861456550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 REGIONAL MEDICAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHARTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77488-9719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-532-1700
Provider Business Mailing Address Fax Number:
979-532-6754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 REGIONAL MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHARTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77488-9719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-532-1700
Provider Business Practice Location Address Fax Number:
979-532-6754
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  E8674 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 139255704 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139255717 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 830003057 . This is a "RAILROAD GBA - RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 89Z781 . This is a "BC/BS TX#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8DE535 . This is a "BC/BS #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P01090501 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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