Healthcare Provider Details

I. General information

NPI: 1285033431
Provider Name (Legal Business Name): MR. ANTHONY ROMANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SE MONTEREY RD STE 102
STUART FL
34994-4512
US

IV. Provider business mailing address

PO BOX 2900
STUART FL
34995-2900
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-2400
  • Fax:
Mailing address:
  • Phone: 772-288-2400
  • Fax: 772-419-0143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4096
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4096
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: