Healthcare Provider Details

I. General information

NPI: 1497726459
Provider Name (Legal Business Name): DAVID CLARKE ROMINE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36000 DARNALL LOOP CREDENTIALS, CRDAMC
FORT HOOD TX
76544-5095
US

IV. Provider business mailing address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

V. Phone/Fax

Practice location:
  • Phone: 254-288-8025
  • Fax:
Mailing address:
  • Phone: 409-722-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberDO1191
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP5459
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO1191
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: