Provider Demographics
NPI:1063643138
Name:ROMAN MUNOZ, ANGEL O (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:O
Last Name:ROMAN MUNOZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5564 E GRANT ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1666
Mailing Address - Country:US
Mailing Address - Phone:321-235-6230
Mailing Address - Fax:321-235-6246
Practice Address - Street 1:5564 E GRANT ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1666
Practice Address - Country:US
Practice Address - Phone:321-235-6230
Practice Address - Fax:321-235-6246
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17695208D00000X
FLACN747208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1144285OtherCAREPLUS
FLJGGFYOtherFLORIDA BLUE
FL1522755OtherWELLCARE
FLP1057987OtherFREEDOM
FLEJ395AOtherMEDICARE
FLP01822984OtherSIMPLY
FLP989491OtherOPTIMUM