Provider Demographics
NPI:1205092343
Name:JAIME LUIS ROMAN-PAVAJEAU, M.D., P.A.
Entity type:Organization
Organization Name:JAIME LUIS ROMAN-PAVAJEAU, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROMAN-PAVAJEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-436-9223
Mailing Address - Street 1:5008 WEDGEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2834
Mailing Address - Country:US
Mailing Address - Phone:281-833-3330
Mailing Address - Fax:281-833-3323
Practice Address - Street 1:1331 W GRAND PKWY N
Practice Address - Street 2:SUITE 330
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2710
Practice Address - Country:US
Practice Address - Phone:281-693-5454
Practice Address - Fax:281-693-5459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM7580OtherTEXAS MEDICAL LICENSE
TX1980856Medicaid
TX1980856Medicaid