Provider Demographics
NPI:1003914953
Name:ROMERO, ALFREDO S (MD)
Entity type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:S
Last Name:ROMERO
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 1:622 COLLINS DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2077
Mailing Address - Country:US
Mailing Address - Phone:636-638-1506
Mailing Address - Fax:636-638-1507
Practice Address - Street 1:1202 E SONTERRA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4238
Practice Address - Country:US
Practice Address - Phone:210-546-1410
Practice Address - Fax:210-546-1419
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3417208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000000769503OtherBCBSMO
MO13003914953Medicaid
P01156923Medicare PIN
MO13003914953Medicaid
MOMA2027014Medicare PIN
MOMA2027014Medicare PIN