Provider Demographics
NPI:1134123904
Name:ROMAN AQUERON, WILLIAM R (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:ROMAN AQUERON
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:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1230
Mailing Address - Country:US
Mailing Address - Phone:787-834-8160
Mailing Address - Fax:787-265-5777
Practice Address - Street 1:746 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1538
Practice Address - Country:US
Practice Address - Phone:787-834-8160
Practice Address - Fax:787-265-5777
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6058208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCU340AOtherMEDICARE GROUP
PRD08726Medicare UPIN
PRCU340AOtherMEDICARE GROUP