Provider Demographics
NPI:1932171832
Name:ENRIQUEZ, ROMAN SUAREZ JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:SUAREZ
Last Name:ENRIQUEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2700 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3251
Mailing Address - Country:US
Mailing Address - Phone:816-421-4240
Mailing Address - Fax:816-421-5015
Practice Address - Street 1:2700 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 400
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3251
Practice Address - Country:US
Practice Address - Phone:816-421-4240
Practice Address - Fax:816-421-5015
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMDR6760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
08411065OtherBCBS OF KC INDIVIDUAL #
MO201218443Medicaid
110231295OtherRAILROAD MEDICARE
D90221Medicare UPIN
08411065OtherBCBS OF KC INDIVIDUAL #