Provider Demographics
NPI:1275654063
Name:ROMAN AVILES, FREDDIE H (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDDIE
Middle Name:H
Last Name:ROMAN AVILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 CALLE PERAL N
Mailing Address - Street 2:OFICINA 1-E
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4861
Mailing Address - Country:US
Mailing Address - Phone:787-833-1060
Mailing Address - Fax:787-265-4025
Practice Address - Street 1:14 CALLE PERAL N
Practice Address - Street 2:OFICINA 1-E
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4861
Practice Address - Country:US
Practice Address - Phone:787-833-1060
Practice Address - Fax:787-265-4025
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3175207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR209033OtherPREFERRED HEALTH
PR7080031OtherHUMANA
PR04415OtherPROSSAM
PR5122OtherIMC
PR94725OtherTRIPLE S OPTIMO
PR1744OtherPMC
PR063248OtherLCA
PR94725OtherTRIPLE S
PR602359OtherMMM
PR6646OtherAMERICAN HEALTH MEDICARE
PR063248OtherLCA
PR602359OtherMMM