MEDICARE: WILLIAM R ROMAN AQUERON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	6058	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CU340A	OTHER	PR	MEDICARE GROUP

General Provider Information

NPI Number	:	1134123904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM R ROMAN AQUERON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1230
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00681-1230
Country	:	US
Telephone Number	:	787-834-8160
Fax Number	:	787-265-5777

Provider Business Practice Location Address
First Line	:	746 AVE HOSTOS
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00682-1538
Country	:	US
Telephone Number	:	787-834-8160
Fax Number	:	787-265-5777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	10/17/2011

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