Provider Demographics
NPI:1740235415
Name:AREVALOS, ENRIQUE ROMO (MD)
Entity type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:ROMO
Last Name:AREVALOS
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 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:3024 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3132
Practice Address - Country:US
Practice Address - Phone:615-851-6033
Practice Address - Fax:615-851-2018
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN238042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509245Medicaid
TNPENDINGOtherRAILROAD MEDICARE
TN1509245OtherMEDICAID - MTI
TN4068871OtherBCBS
TN4200905OtherBCBS TN
TN3889765Medicaid
TN4068493OtherBCBS
TN4291399OtherBCBS - MTI
KY64108897OtherKY MEDICAID
TN10330I6917Medicare PIN
TN4068493OtherBCBS
TN4068871OtherBCBS
TN3889765Medicaid
TN38897661Medicare PIN
TN103I305929Medicare PIN