Healthcare Provider Details

I. General information

NPI: 1124049259
Provider Name (Legal Business Name): IDAR ERIC ROMMEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 UNIVERSITY AVE
MONROE LA
71203
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-8266
  • Fax:
Mailing address:
  • Phone: 318-966-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00020810
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number344523
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: