Provider Demographics
NPI:1497717045
Name:ROMAN-LOPEZ, JUAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:J
Last Name:ROMAN-LOPEZ
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 1:4301 W MARKHAM ST SLOT 793
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-296-1099
Mailing Address - Fax:501-526-6562
Practice Address - Street 1:4301 W MARKHAM ST SLOT 793
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-296-1099
Practice Address - Fax:501-526-6562
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-1991207VX0201X
ARR1991207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARDO8992Medicare UPIN
AR54534Medicare PIN