Provider Demographics
NPI:1114019379
Name:JOHN D ROMM MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JOHN D ROMM MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-654-5638
Mailing Address - Street 1:8920 WILSHIRE BLVD
Mailing Address - Street 2:STE #330
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2007
Mailing Address - Country:US
Mailing Address - Phone:310-854-5638
Mailing Address - Fax:
Practice Address - Street 1:8920 WILSHIRE BLVD
Practice Address - Street 2:STE #330
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2007
Practice Address - Country:US
Practice Address - Phone:310-854-5638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC19015207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC19045Medicare PIN