Provider Demographics
NPI:1881803088
Name:LOPEZ-ROMAN, ORLANDO ALFREDO (MD)
Entity type:Individual
Prefix:
First Name:ORLANDO
Middle Name:ALFREDO
Last Name:LOPEZ-ROMAN
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 1:1010 THREE SPRINGS BLVD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8296
Mailing Address - Country:US
Mailing Address - Phone:970-764-3800
Mailing Address - Fax:970-764-3643
Practice Address - Street 1:1010 THREE SPRINGS BLVD
Practice Address - Street 2:SUITE 255
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-8296
Practice Address - Country:US
Practice Address - Phone:970-764-3800
Practice Address - Fax:970-764-3643
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8948207RG0100X
CODR.0053090207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286998401Medicaid
BP1-0017766OtherINSTITUTIONAL PERMIT
BP1-0017766OtherINSTITUTIONAL PERMIT