Provider Demographics
NPI:1710070438
Name:NATION, ROMAN MICHAEL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:MICHAEL JAMES
Last Name:NATION
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 1:1514 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2905
Mailing Address - Country:US
Mailing Address - Phone:850-481-1101
Mailing Address - Fax:850-441-3748
Practice Address - Street 1:1514 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2905
Practice Address - Country:US
Practice Address - Phone:885-481-1101
Practice Address - Fax:850-640-3949
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93829207Q00000X
FLME109512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003915500Medicaid