Individual
GUSTAVO ROMAN
Active
Individual
GUSTAVO ROMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
G4389
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295745693
BLUE CROSS BLUE SHIELD
TX
05
—
133793303
—
TX
01
—
133793304
CIDC
TX
05
—
133793310
—
TX
01
—
P00846906
MEDICARE RAILROAD
TX
01
—
P01234694
MEDICARE RR
TX
Enumeration date
08/08/2006
Last updated
02/18/2014
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