Provider Demographics
NPI:1376534396
Name:ROOME, GARY T (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:T
Last Name:ROOME
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 1:225 E 5TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1641
Mailing Address - Country:US
Mailing Address - Phone:810-406-4246
Mailing Address - Fax:810-424-6029
Practice Address - Street 1:G-3375 S. SAGINAW ST.
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529
Practice Address - Country:US
Practice Address - Phone:810-743-6830
Practice Address - Fax:810-743-7086
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB48439OtherHEALTH ALLIANCE PLAN
MI080095915OtherMETRAHEALTH
MI0802532881OtherBLUE CROSS BLUE SHIELD
MI204391OtherMCLAREN HEALTH PLAN
MI4974960Medicaid
MI204391OtherHEALTH ADVANTAGE NETWORK
MI3302570Medicaid
MIB48439OtherHEALTH NET FEDERAL SERV
MI1919555001OtherCIGNA
MI4378496OtherAETNA
MI080D410020OtherCOMMUNITY BLUE
MI080D410020OtherBLUE CARE NETWORK
MIC2387OtherMCARE
MA080D410020OtherBLUE CROSS BLUE SHIELD
MI080D410020OtherBLUE CHOICE POS
MI2032240OtherHEALTH PLUS
MI2032240OtherHEALTH PLUS
MIC2387OtherMCARE
MI080D410020OtherBLUE CHOICE POS
MI4378496OtherAETNA