Healthcare Provider Details

I. General information

NPI: 1912025503
Provider Name (Legal Business Name): RICARDO A ROIS ROMERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5462 VILLAGE DR
ROCKLEDGE FL
32955-6569
US

IV. Provider business mailing address

5462 VILLAGE DR
ROCKLEDGE FL
32955-6569
US

V. Phone/Fax

Practice location:
  • Phone: 321-421-7122
  • Fax: 866-611-2535
Mailing address:
  • Phone: 321-421-7122
  • Fax: 866-611-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD110773
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME110773
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME110773
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: