Provider Demographics
NPI:1407938681
Name:ROMERO, RAUL D (MD)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:D
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 1:303 E BASELINE RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6530
Mailing Address - Country:US
Mailing Address - Phone:602-243-3455
Mailing Address - Fax:602-243-3404
Practice Address - Street 1:303 E BASELINE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6530
Practice Address - Country:US
Practice Address - Phone:602-243-3455
Practice Address - Fax:602-243-3404
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ17336207QA0505X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ276792Medicaid
AZAZ0854030OtherBLUE CROSS ID
AZC74515Medicare UPIN
AZ276792Medicaid