Provider Demographics
NPI:1497748156
Name:ROMAN, JESUS M (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:M
Last Name:ROMAN
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:CPR PROFESSIONAL BUILDING
Mailing Address - Street 2:55 CALLE DE DIEGO ESTE SUITE 401
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-5081
Mailing Address - Country:US
Mailing Address - Phone:787-832-0000
Mailing Address - Fax:
Practice Address - Street 1:55 CALLE DE DIEGO ESTE SUITE 401
Practice Address - Street 2:CPR PROFESSIONAL BUILDING
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15615207R00000X, 207RB0002X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine