Provider Demographics
NPI:1497718217
Name:LAYGO, ROMUALDO M (MD)
Entity Type:Individual
Prefix:
First Name:ROMUALDO
Middle Name:M
Last Name:LAYGO
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 818
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-0818
Mailing Address - Country:US
Mailing Address - Phone:912-754-1035
Mailing Address - Fax:912-754-1037
Practice Address - Street 1:1451 HIGHWAY 21 S STE H
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329-5244
Practice Address - Country:US
Practice Address - Phone:912-754-1035
Practice Address - Fax:912-754-1037
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017843207Q00000X, 208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00114067DMedicaid
GA406021649OtherPALMETTO GBA RAILROAD MED
D30028Medicare UPIN