Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | R3417 | TX |
Y | 2081P2900X | Pain Medicine | R3417 | TX |
NPI | 1003914953 |
---|---|
Provider Name | Dr. Alfredo S Romero |
First Address | Festus, MO 63028-2077 |
Second Address | San Antonio, TX 78258-4238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 04/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000769503 | BCBSMO (01) | MO |
13003914953 | (05) | MO |