Provider Demographics
NPI:1851361745
Name:ROMAN, JOSE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:ROMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SE 17TH ST
Mailing Address - Street 2:BLDG 100
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4191
Mailing Address - Country:US
Mailing Address - Phone:352-351-4999
Mailing Address - Fax:352-351-8106
Practice Address - Street 1:1800 SE 17TH ST
Practice Address - Street 2:BLDG 100
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4191
Practice Address - Country:US
Practice Address - Phone:352-351-4999
Practice Address - Fax:352-351-8106
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23995OtherBCBS
FL374870700Medicaid
FLP00013635Medicare PIN
FL23995WMedicare PIN
FL23995OtherBCBS
FL23995SMedicare PIN