Healthcare Provider Details

I. General information

NPI: 1144233602
Provider Name (Legal Business Name): GERARDO ERNESTO PEREZ-ROMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 CALLE CESAR GONZALEZ DORAL BANK CENTER SUITE 402
SAN JUAN PR
00918-3756
US

IV. Provider business mailing address

576 CALLE CESAR GONZALEZ DORAL BANK CENTER SUITE 402
SAN JUAN PR
00918-3756
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-5085
  • Fax: 787-767-6876
Mailing address:
  • Phone: 787-767-5085
  • Fax: 787-767-6876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number12262
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number12262
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: