Basic Information
| Provider Information | |||||||||
| NPI: | 1093783276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMAN | ||||||||
| FirstName: | DIVINA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1919 S WHEELING AVE | ||||||||
| Address2: | 200 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741045638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187487600 | ||||||||
| FaxNumber: | 9182933109 | ||||||||
| Practice Location | |||||||||
| Address1: | 1919 S WHEELING AVE | ||||||||
| Address2: | 200 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741045638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187487600 | ||||||||
| FaxNumber: | 9182933109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 10/29/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0000X | 18436 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine |
No ID Information.