Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0208X | Pediatric Infectious Diseases | 19225 | NE |
Y | 2080P0208X | Pediatric Infectious Diseases | E-5819 | AR |
NPI | 1205887163 |
---|---|
Provider Name | Jose R Romero |
First Address | Little Rock, AR 72202-3500 |
Second Address | Little Rock, AR 72202-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 11/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124801001 | (05) | AR |
47078557559 | (05) | NE |
A64758 | (02) | NE |