MEDICARE: HAROLD A ROMERO P.A.

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	363AS0400X	Surgical Physician Assistant	2827	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	118638	OTHER	AZ	MEDICARE PROVIDER NUMBER

General Provider Information

NPI Number	:	1669476461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAROLD A ROMERO P.A.

Provider Business Mailing Address
First Line	:	4727 E CAMP LOWELL DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1256
Country	:	US
Telephone Number	:	520-290-4263
Fax Number	:	520-323-2716

Provider Business Practice Location Address
First Line	:	4727 E. CAMP LOWELL DRIVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1256
Country	:	US
Telephone Number	:	520-290-4263
Fax Number	:	520-323-2716

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	01/17/2008

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Directions to “ HAROLD A ROMERO P.A.” Practice Location

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