Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 16121 | GA |
NPI | 1003963265 |
---|---|
Provider Name | Dr. Romulo Laureta Parungao |
First Address | Conyers, GA 30094-3423 |
Second Address | Fort Defiance, AZ 86504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 21/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00085566R-0 | (05) | GA |
D30421 | (02) |