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General NPI Number Information
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NPI Number | 1710946520
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Entity Type | Individual
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Provider Name | JOSE EMILIO ROMAN-CANDELARIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 05/01/2018
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Provider Practice Location Address
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Address Line | 307 BOATNER ROAD, SUITE 114 96TH MEDICAL OPERATIONS SQUADRON
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City | EGLIN AFB
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State | FL
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Zip | 32542
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Country | US
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Telephone | 850-883-8358
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Fax | 850-883-8517
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Provider Business Mailing Address
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Address Line | 307 BOATNER RD STE 114
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City | EGLIN AFB
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State | FL
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Zip | 32542-1302
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Country | US
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Telephone | 850-883-8197
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Fax | 850-883-1042
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 17974
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License Number State | MS
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