Provider Demographics
NPI:1518157031
Name:LAINEZ, ROMEO A (MD)
Entity Type:Individual
Prefix:
First Name:ROMEO
Middle Name:A
Last Name:LAINEZ
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 1:3705 MEDICAL PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1022
Mailing Address - Country:US
Mailing Address - Phone:512-302-1210
Mailing Address - Fax:512-451-9752
Practice Address - Street 1:3705 MEDICAL PKWY STE 250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1022
Practice Address - Country:US
Practice Address - Phone:512-302-1210
Practice Address - Fax:512-451-9752
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5404208600000X
LA202831208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1000809Medicaid