Provider Demographics
NPI:1053335851
Name:ROMERO, ORESTES (MD)
Entity type:Individual
Prefix:
First Name:ORESTES
Middle Name:
Last Name:ROMERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4258
Mailing Address - Street 2:STE 205 W
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-4258
Mailing Address - Country:US
Mailing Address - Phone:361-570-1200
Mailing Address - Fax:361-570-1220
Practice Address - Street 1:601 E SAN ANTONIO ST
Practice Address - Street 2:STE 205 W
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6002
Practice Address - Country:US
Practice Address - Phone:361-570-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167237001Medicaid
TX8P9060OtherBLUE CROSS
TX8C1644Medicare PIN
TX8P9060OtherBLUE CROSS
TXP00180183Medicare PIN