Provider Demographics
NPI:1639132871
Name:ROMAN, FRANKIE R (MD)
Entity Type:Individual
Prefix:
First Name:FRANKIE
Middle Name:R
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:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:13020 MERIDIAN AVE S
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:206-386-4744
Practice Address - Fax:206-215-1135
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064187207RS0012X
WAMD60806364207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0906916Medicaid
OHE68001Medicare UPIN
H245060Medicare PIN
OHE68001Medicare UPIN
OH341840860COtherSUMMACARE
OH341097565OOtherAULTCARE
OH0906916Medicaid
OH290009158OtherRAILROAD MEDICARE
0796472Medicare PIN