MEDICARE: DR. ROMEO S COLINA MD

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	207Q00000X	Family Medicine Physician	ME29220	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	:	1972575967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROMEO S COLINA MD

Provider Business Mailing Address
First Line	:	1900 NEBRASKA AVE
Second Line	:	#8
City	:	FT PIERCE
State	:	FL
Zip	:	34950-4837
Country	:	US
Telephone Number	:	772-465-2055
Fax Number	:	772-465-0328

Provider Business Practice Location Address
First Line	:	1900 NEBRASKA AVE
Second Line	:	#8
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4837
Country	:	US
Telephone Number	:	772-465-2055
Fax Number	:	772-465-0328

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	09/09/2010

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