Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 12560 | FL |
NPI | 1861967879 |
---|---|
Provider Name | Dr. Thomas Alfred Romero |
First Address | Ponte Vedra Beach, FL 32082-3554 |
Second Address | Ponte Vedra Beach, FL 32082-3554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2018 |
Last Update Date | 05/10/2018 |