Healthcare Provider Details

I. General information

NPI: 1164755534
Provider Name (Legal Business Name): RICHARD E. ROMM M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2082 DOGWOOD DR
EUGENE OR
97405-7007
US

IV. Provider business mailing address

PO BOX 5567
EUGENE OR
97405-0567
US

V. Phone/Fax

Practice location:
  • Phone: 541-359-7697
  • Fax:
Mailing address:
  • Phone: 541-359-7697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number09615
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CATRINA MARIE THOMAS
Title or Position: MANAGER
Credential:
Phone: 541-359-7697