Provider Demographics
NPI:1720116056
Name:KROMA, GHAZWAN MOHAMMAD FAOZI (MD)
Entity Type:Individual
Prefix:DR
First Name:GHAZWAN
Middle Name:MOHAMMAD FAOZI
Last Name:KROMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 BLUEMEL RD APT 202
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1066
Mailing Address - Country:US
Mailing Address - Phone:210-641-9563
Mailing Address - Fax:
Practice Address - Street 1:7703 FLOYD CURL DRIVE
Practice Address - Street 2:RADIOLOGY, UNIV TEXAS HEALTH SCIENCE CENTER
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-567-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010893402085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187587401Medicaid
TX8L11256Medicare PIN