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General NPI Number Information
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NPI Number | 1083242275
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Entity Type | Individual
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Provider Name | LINDA DE ROMANETT M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 1115 HONEYSUCKLE DRIVE
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City | KEENE
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State | TX
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Zip | 76059-2101
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Country | US
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Telephone | 817-641-3495
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 HONEYSUCKLE DRIVE
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City | KEENE
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State | TX
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Zip | 76059-2101
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Country | US
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Telephone | 817-641-3495
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 13703
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 12972
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 14291
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License Number State | OK
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