Provider Demographics
NPI:1275618381
Name:ROMNEY, DOUGLAS P (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:P
Last Name:ROMNEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W FRANCIS
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205
Mailing Address - Country:US
Mailing Address - Phone:509-483-9363
Mailing Address - Fax:509-483-0355
Practice Address - Street 1:123 W FRANCIS
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205
Practice Address - Country:US
Practice Address - Phone:509-483-9363
Practice Address - Fax:509-483-0355
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP000000308213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1939602Medicaid
WA22743OtherLABOR AND INDUSTRY
WA480006081OtherRAILROAD MEDICARE
WAG000301355Medicare PIN
WA22743OtherLABOR AND INDUSTRY
WA1939602Medicaid
T02382Medicare UPIN
WAG000301989Medicare PIN