Provider Demographics
NPI:1285652453
Name:ROMERO, ROBERT W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:ROMERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 53709
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-3709
Mailing Address - Country:US
Mailing Address - Phone:337-981-7546
Mailing Address - Fax:337-988-2037
Practice Address - Street 1:4212 W CONGRESS ST
Practice Address - Street 2:STE 2300
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6765
Practice Address - Country:US
Practice Address - Phone:337-981-7546
Practice Address - Fax:337-988-2037
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA011162207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1159263Medicaid
B89885Medicare UPIN
LA1159263Medicaid