Provider Demographics
NPI:1922065713
Name:ROMAN, JUSTO MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:JUSTO
Middle Name:MANUEL
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 1:5255 OFFICE PARK BLVD STE 110
Mailing Address - Street 2:APC PEDIATRICS
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-3443
Mailing Address - Country:US
Mailing Address - Phone:941-755-7000
Mailing Address - Fax:941-755-7088
Practice Address - Street 1:5255 OFFICE PARK BLVD STE 110
Practice Address - Street 2:APC PEDIATRICS
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-3443
Practice Address - Country:US
Practice Address - Phone:941-755-7000
Practice Address - Fax:941-755-7088
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1094208000000X
FLME11223208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007370200Medicaid