Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 12262 | PR |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 12262 | PR |
NPI | 1144233602 |
---|---|
Provider Name | Gerardo Ernesto Perez-Roman |
First Address | San Juan, PR 00918-3756 |
Second Address | San Juan, PR 00918-3756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 21/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060954 | LA CRUZ AZUL DE PR (01) | PR |
90073 | TRIPLE S (01) | PR |
G78104 | (02) | PR |