Provider Demographics
NPI:1144233602
Name:PEREZ-ROMAN, GERARDO ERNESTO (MD)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:ERNESTO
Last Name:PEREZ-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 1:576 CALLE CESAR GONZALEZ
Mailing Address - Street 2:DORAL BANK CENTER SUITE 402
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3756
Mailing Address - Country:US
Mailing Address - Phone:787-767-5085
Mailing Address - Fax:787-767-6876
Practice Address - Street 1:576 CALLE CESAR GONZALEZ
Practice Address - Street 2:DORAL BANK CENTER SUITE 402
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3756
Practice Address - Country:US
Practice Address - Phone:787-767-5085
Practice Address - Fax:787-767-6876
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12262207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR060954OtherLA CRUZ AZUL DE PR
PR90073OtherTRIPLE S
PRG78104Medicare UPIN
PR060954OtherLA CRUZ AZUL DE PR