Provider Demographics
NPI:1851358998
Name:ROMERO, JASON JUDE (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JUDE
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 1:845 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2101
Mailing Address - Country:US
Mailing Address - Phone:318-222-3278
Mailing Address - Fax:318-424-3155
Practice Address - Street 1:845 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2101
Practice Address - Country:US
Practice Address - Phone:318-222-3278
Practice Address - Fax:318-424-3155
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026086207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1054097Medicaid
LA1054097Medicaid