Provider Demographics
NPI:1871832113
Name:ROMAN ERIK TAVAREZ M.D., P.A.
Entity Type:Organization
Organization Name:ROMAN ERIK TAVAREZ M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:ERIK
Authorized Official - Last Name:TAVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:956-683-7959
Mailing Address - Street 1:1801 S 5TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-2919
Mailing Address - Country:US
Mailing Address - Phone:956-683-7959
Mailing Address - Fax:956-683-7983
Practice Address - Street 1:1801 S 5TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2919
Practice Address - Country:US
Practice Address - Phone:956-683-7959
Practice Address - Fax:956-683-7983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAVAREZ FAMILY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-06
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N7181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH06818Medicare UPIN