Healthcare Provider Details

I. General information

NPI: 1023016276
Provider Name (Legal Business Name): RICHARD ROMM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 E 12TH AVE SUITE N400
EUGENE OR
97401-3600
US

IV. Provider business mailing address

677 E 12TH AVE SUITE N400
EUGENE OR
97401-3600
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-4332
  • Fax: 541-302-0786
Mailing address:
  • Phone: 541-484-4332
  • Fax: 541-302-0786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD09615
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: