Provider Demographics
NPI:1912998220
Name:FEBRES ROMAN, PEDRO REGALADO SR (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:REGALADO
Last Name:FEBRES ROMAN
Suffix:SR
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:PO BOX 4398
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95352-4398
Mailing Address - Country:US
Mailing Address - Phone:209-575-4575
Mailing Address - Fax:209-575-4598
Practice Address - Street 1:2141 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2011
Practice Address - Country:US
Practice Address - Phone:209-634-2600
Practice Address - Fax:209-634-2699
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29593207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA295930OtherBLUE SHIELD
CAOOA295930Medicaid
CAOOA295930OtherBLUE SHIELD
CA00A295931Medicare PIN
CA00A295935Medicare PIN
CA1194864769Medicare PIN