Provider Demographics
NPI:1770691826
Name:ROMAGUERA, GERARD A (MD)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:A
Last Name:ROMAGUERA
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 1:316 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053
Mailing Address - Country:US
Mailing Address - Phone:504-391-0077
Mailing Address - Fax:504-394-6827
Practice Address - Street 1:316 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053
Practice Address - Country:US
Practice Address - Phone:504-391-0077
Practice Address - Fax:504-394-6827
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1339270Medicaid
LA5CM67Medicare ID - Type Unspecified
LAB61452Medicare UPIN