Provider Demographics
NPI:1851366355
Name:ROMAN, FARID (MD)
Entity Type:Individual
Prefix:
First Name:FARID
Middle Name:
Last Name:ROMAN
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 1:11155 DUNN RD STE 109N
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6148
Mailing Address - Country:US
Mailing Address - Phone:314-953-8799
Mailing Address - Fax:314-953-8798
Practice Address - Street 1:11155 DUNN RD STE 109N
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6148
Practice Address - Country:US
Practice Address - Phone:314-953-8799
Practice Address - Fax:314-953-8798
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36790207RE0101X
IL036.127376207RE0101X
MO2011000768207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00120072OtherMEDICARE RAILROAD
TN3890875Medicare PIN
P00120072OtherMEDICARE RAILROAD