Individual
MR. MARK DAVID ROMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
225 MARY WALLACE WAY, DALLAS, GA 30157-5054
(770) 608-3302
Mailing address
10 KRUGER RD, PLAINS, MT 59859-9271
(406) 826-4800
(406) 826-4811
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9101641
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291095100
—
FL
Enumeration date
06/29/2006
Last updated
08/13/2018
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