Healthcare Provider Details

I. General information

NPI: 1124220595
Provider Name (Legal Business Name): ALEX ANTHONY ROMERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 OUTLOOK BLVD SUITE 37
PUEBLO CO
81008-1667
US

IV. Provider business mailing address

4112 OUTLOOK BLVD SUITE 37
PUEBLO CO
81008-1667
US

V. Phone/Fax

Practice location:
  • Phone: 719-562-6254
  • Fax: 719-562-6255
Mailing address:
  • Phone: 719-562-6254
  • Fax: 719-562-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number49674
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number49674
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA111830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: