MEDICARE: RENATO ROMERO 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	2084P0800X	Psychiatry Physician	ME0022945	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205984606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENATO ROMERO M.D.

Provider Business Mailing Address
First Line	:	5378 OAK BAY DR N
Second Line	:	JACKSONVILLE
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-1011
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11265 ALUMNI WAY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7630
Country	:	US
Telephone Number	:	904-743-2968
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	02/20/2019

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