Provider Demographics
NPI:1841252988
Name:CHAM, ROMAN B (MD)
Entity type:Individual
Prefix:
First Name:ROMAN
Middle Name:B
Last Name:CHAM
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:7339 EL CAJON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7435
Mailing Address - Country:US
Mailing Address - Phone:619-668-0900
Mailing Address - Fax:619-668-0265
Practice Address - Street 1:7339 EL CAJON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7435
Practice Address - Country:US
Practice Address - Phone:619-668-0900
Practice Address - Fax:619-668-0265
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2014-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA37068174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37068Medicare UPIN
CAA37068Medicare UPIN