Roman, Terry Mark

Roman, Terry Mark is an individual health care provider with primary practice located at 123 Hospital Dr Suite 1008, Watertown WI 53098-3331. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Roman, Terry Mark can be contacted via phone (920) 206-6500.

Contact Information

Primary practice address
123 Hospital Dr Suite 1008 Watertown WI 53098-3331
Phone: (920) 206-6500
Fax: (920) 261-4013
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 54555-021 Wisconsin

Profile Details

NPI number 1083895312
LBN Legal business name Roman, Terry Mark
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2007
Last updated Aug 29th, 2013 - about 13 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 1083895312 NPPES
Wisconsin MEDICAID 1083895312

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