Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 26622R | PR |
N | 111NI0900X | Internist | 26622R | PR |
N | 207RH0000X | Hematologist | ME124921 | FL |
N | 207RH0003X | Hematology & Oncology | ME124921 | FL |
N | 207RX0202X | Medical Oncology | 17027 | PR |
Y | 207RX0202X | Medical Oncology | ME124921 | FL |
NPI | 1285822924 |
---|---|
Provider Name | Jaime Luis Roman-Diaz |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Cape Coral, FL 33914-6985 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2007 |
Last Update Date | 19/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015504400 | (05) | FL |