Basic Information
| Provider Information | |||||||||
| NPI: | 1851361745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROMAN | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 SE 17TH ST | ||||||||
| Address2: | BLDG 100 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344714191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523514999 | ||||||||
| FaxNumber: | 3523518106 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 SE 17TH ST | ||||||||
| Address2: | BLDG 100 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344714191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523514999 | ||||||||
| FaxNumber: | 3523518106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 02/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME65784 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 23995 | 01 | FL | BCBS | OTHER | 374870700 | 05 | FL | MEDICAID |