Provider Demographics
NPI:1205887163
Name:ROMERO, JOSE R (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:ROMERO
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1 CHILDRENS WAY # 512-11
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1416
Mailing Address - Fax:501-364-3551
Practice Address - Street 1:1 CHILDRENS WAY # 512-11
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1416
Practice Address - Fax:501-364-3551
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE192252080P0208X
ARE-58192080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124801001Medicaid
NE47078557559Medicaid
AR5H341Medicare PIN
NE266579Medicare ID - Type Unspecified
AR124801001Medicaid