1144324369 NPI number — JORGE LUIS ROMEU M.D.

Table of content: JORGE LUIS ROMEU M.D. (NPI 1144324369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144324369 NPI number — JORGE LUIS ROMEU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMEU
Provider First Name:
JORGE
Provider Middle Name:
LUIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROMEU VELEZ
Provider Other First Name:
JORGE
Provider Other Middle Name:
LUIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144324369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1703 N LOOP 1604 W
Provider Second Line Business Mailing Address:
APT #12102
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-4677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-220-9136
Provider Business Mailing Address Fax Number:
210-541-9123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5414 FREDERICKSBURG RD, STE 100
Provider Second Line Business Practice Location Address:
PEDIATRIX MEDICAL GROUP
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-541-8281
Provider Business Practice Location Address Fax Number:
210-541-9123
Provider Enumeration Date:
09/08/2006

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: 2080N0001X , with the licence number:  M4486 , 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)