Healthcare Provider Details

I. General information

NPI: 1487623658
Provider Name (Legal Business Name): LORENZO MILES ROMNEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 S. 65 HWY
MARSHALL MO
65340-0250
US

IV. Provider business mailing address

2305 S. 65 HWY
MARSHALL MO
65340-0250
US

V. Phone/Fax

Practice location:
  • Phone: 660-886-7431
  • Fax: 660-831-3328
Mailing address:
  • Phone: 660-886-7431
  • Fax: 660-831-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number109668
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number109668
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: