Provider Demographics
NPI:1336114073
Name:ROMINE, JAMES C (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:ROMINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:AR
Mailing Address - Zip Code:72741-0523
Mailing Address - Country:US
Mailing Address - Phone:479-521-4433
Mailing Address - Fax:479-521-0444
Practice Address - Street 1:4301 GREATHOUSE SPRINGS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:JOHNSON
Practice Address - State:AR
Practice Address - Zip Code:72741-0523
Practice Address - Country:US
Practice Address - Phone:479-521-4433
Practice Address - Fax:479-521-0444
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC3372207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106281001Medicaid
ARC3372OtherSTATE LICENSE
AR54536Medicare PIN
AR545367267Medicare PIN
ARD04886Medicare UPIN