Basic Information
| Provider Information | |||||||||
| NPI: | 1982661187 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAJAR | ||||||||
| FirstName: | ROMANO | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 683 | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511020683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122552324 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2720 STONE PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511043734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122552324 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 05/01/2008 | ||||||||
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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 | 207L00000X | 31111 | IA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0145581 | 05 | IA | MEDICAID | 0143867 | 05 | IA | MEDICAID |