Provider Demographics
NPI:1174520019
Name:ROMAN, ANGEL MANUEL JR (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:MANUEL
Last Name:ROMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2833 BABCOCK RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5390
Mailing Address - Country:US
Mailing Address - Phone:210-692-2000
Mailing Address - Fax:210-692-2010
Practice Address - Street 1:2833 BABCOCK RD
Practice Address - Street 2:SUITE 315
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5390
Practice Address - Country:US
Practice Address - Phone:210-692-2000
Practice Address - Fax:210-692-2010
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2009-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF1948208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138918109Medicaid
TXC21258Medicare UPIN
TX138918109Medicaid