Icasiano, Romeo Gonzaga

Icasiano, Romeo Gonzaga is an individual health care provider with primary practice located at 947 So 5Th St , Montrose CO 81401-5716. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Icasiano, Romeo Gonzaga can be contacted via phone (870) 249-2421.

Contact Information

Primary practice address
947 So 5Th St Montrose CO 81401-5716
Phone: (870) 249-2421
Fax: (970) 249-8897
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 37326 Colorado

Profile Details

NPI number 1114928066
LBN Legal business name Icasiano, Romeo Gonzaga
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 2nd, 2005
Last updated Apr 10th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114928066 NPPES
Colorado MEDICAID 01373265

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