Provider Demographics
NPI:1023166717
Name:ROMAN, JOSEPH JASON (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JASON
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 1:1602 ROCK PRAIRIE RD
Mailing Address - Street 2:SUITE 4880
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8306
Mailing Address - Country:US
Mailing Address - Phone:979-764-1111
Mailing Address - Fax:979-693-2753
Practice Address - Street 1:1602 ROCK PRAIRIE RD
Practice Address - Street 2:SUITE 4880
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8306
Practice Address - Country:US
Practice Address - Phone:979-796-1111
Practice Address - Fax:979-764-1164
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23489207R00000X
TXM6365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186719401Medicaid
TX8K7733OtherBLUE CROSS
TX8K7733OtherBLUE CROSS
TX186719401Medicaid