Individual
GUSTAVO ROMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6560 FANNIN ST, SUITE 802, HOUSTON, TX 77030-2761
(713) 441-1150
(713) 790-4990
Mailing address
6560 FANNIN ST, SUITE 802, HOUSTON, TX 77030-2761
(713) 441-1150
(713) 790-4990
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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