Provider Demographics
NPI:1124001334
Name:ROMAN, RICARDO J (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:J
Last Name:ROMAN
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 1:16855 NE 2ND AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1744
Mailing Address - Country:US
Mailing Address - Phone:305-770-0062
Mailing Address - Fax:305-770-1060
Practice Address - Street 1:16855 NE 2ND AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1744
Practice Address - Country:US
Practice Address - Phone:305-770-0062
Practice Address - Fax:305-770-1060
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046568207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062388100Medicaid
FL062388100Medicaid
D63985Medicare UPIN