Healthcare Provider Details

I. General information

NPI: 1134123904
Provider Name (Legal Business Name): WILLIAM R ROMAN AQUERON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 AVE HOSTOS
MAYAGUEZ PR
00682-1538
US

IV. Provider business mailing address

PO BOX 1230
MAYAGUEZ PR
00681-1230
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-8160
  • Fax: 787-265-5777
Mailing address:
  • Phone: 787-834-8160
  • Fax: 787-265-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number6058
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: