Healthcare Provider Details

I. General information

NPI: 1659346674
Provider Name (Legal Business Name): JOSE LOPEZ-ROMERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 BOWMAN ST STE C
MORRISTOWN TN
37813-3871
US

IV. Provider business mailing address

230 BOWMAN ST STE C
MORRISTOWN TN
37813-3871
US

V. Phone/Fax

Practice location:
  • Phone: 423-586-3249
  • Fax: 423-586-3250
Mailing address:
  • Phone: 423-586-3249
  • Fax: 423-586-3250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD0000040243
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number40243
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: