Provider Demographics
NPI:1710946520
Name:ROMAN-CANDELARIA, JOSE EMILIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:EMILIO
Last Name:ROMAN-CANDELARIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:EMILIO
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:307 BOATNER RD STE 114
Mailing Address - Street 2:
Mailing Address - City:EGLIN AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32542-1302
Mailing Address - Country:US
Mailing Address - Phone:850-883-8197
Mailing Address - Fax:850-883-1042
Practice Address - Street 1:307 BOATNER ROAD, SUITE 114
Practice Address - Street 2:96TH MEDICAL OPERATIONS SQUADRON
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542
Practice Address - Country:US
Practice Address - Phone:850-883-8358
Practice Address - Fax:850-883-8517
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17974207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease