Provider Demographics
NPI:1346316114
Name:ROMINE, JOHN STANLEY
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STANLEY
Last Name:ROMINE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:ROMINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:708 OCIO PL
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4022
Mailing Address - Country:US
Mailing Address - Phone:505-327-1389
Mailing Address - Fax:
Practice Address - Street 1:708 OCIO PL
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4022
Practice Address - Country:US
Practice Address - Phone:505-327-1389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM73-61204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D43283Medicare UPIN