Provider Demographics
NPI:1902865108
Name:ROMERO, IRMA E (MD)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:E
Last Name:ROMERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 SW PORT ST LUCIE BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2091
Mailing Address - Country:US
Mailing Address - Phone:772-237-4518
Mailing Address - Fax:772-237-4622
Practice Address - Street 1:466 SW PORT ST LUCIE BLVD STE 116
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2091
Practice Address - Country:US
Practice Address - Phone:772-237-4518
Practice Address - Fax:772-237-4622
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91787208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52148OtherBCBS PROVIDER #
FL271863400Medicaid
FL52148OtherBCBS PROVIDER #
FLH16482Medicare UPIN