Provider Demographics
NPI:1477584381
Name:ROMERO, JORGE RAUL (MD)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:RAUL
Last Name:ROMERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6659 FRANK AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7259
Mailing Address - Country:US
Mailing Address - Phone:330-966-9090
Mailing Address - Fax:330-966-9030
Practice Address - Street 1:6555 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7265
Practice Address - Country:US
Practice Address - Phone:330-966-9090
Practice Address - Fax:330-966-9030
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063466207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0644474OtherAETNA
87497OtherQUALCHOICE
160040923OtherRAILROAD MEDICARE
OH000000137196OtherANTHEM BLUE CROSS BLUE SH
OH0876020Medicaid
3892966OtherCIGNA HEALTHCARE
0026486OtherCHAMPUS CHAMP VA
OH0876020Medicaid