Provider Demographics
NPI:1356322234
Name:ROMERO, CARLOS M (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:M
Last Name:ROMERO
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 1089
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33846-1089
Mailing Address - Country:US
Mailing Address - Phone:863-619-5999
Mailing Address - Fax:863-619-5995
Practice Address - Street 1:3655 INNOVATION DRIVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812
Practice Address - Country:US
Practice Address - Phone:863-619-5999
Practice Address - Fax:863-619-5958
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0085763207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265376100Medicaid
FLH72841Medicare UPIN