Provider Demographics
NPI:1790708287
Name:ROMERO, JORGE ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ANTONIO
Last Name:ROMERO
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 1:3600 GASTON AVE
Mailing Address - Street 2:BARNETT TOWER, SUITE 901
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-827-5525
Mailing Address - Fax:214-827-5441
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:SUITE 901
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-827-5525
Practice Address - Fax:214-827-5441
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK42172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044560302Medicaid
TX044560304Medicaid
TX130024052OtherRR MEDICARE
TX8B4363OtherBCBS
TX130025253OtherRR MEDICARE
TX044560302Medicaid
B98761Medicare UPIN
TX130024052OtherRR MEDICARE