Provider Demographics
NPI:1801871439
Name:ROAN, RALPH ROMAN (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:ROMAN
Last Name:ROAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RALPH
Other - Middle Name:
Other - Last Name:ROAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3838 CALIFORNIA ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1522
Mailing Address - Country:US
Mailing Address - Phone:415-752-1001
Mailing Address - Fax:415-752-0540
Practice Address - Street 1:3838 CALIFORNIA ST
Practice Address - Street 2:SUITE 610
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1522
Practice Address - Country:US
Practice Address - Phone:415-752-1001
Practice Address - Fax:415-752-0540
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC315740208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34625Medicare UPIN