Healthcare Provider Details

I. General information

NPI: 1417164013
Provider Name (Legal Business Name): COREY ROMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/06/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 MEDICAL CENTER RD
FORT HOOD TX
76544
US

IV. Provider business mailing address

590 MEDICAL CENTER RD
FORT HOOD TX
76544
US

V. Phone/Fax

Practice location:
  • Phone: 254-553-5970
  • Fax:
Mailing address:
  • Phone: 254-288-5970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME103777
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number103777
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number015928
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: