Provider Demographics
NPI:1518950302
Name:ROMINES, ROBERT BURNS (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BURNS
Last Name:ROMINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1698 OLD LEBANON RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9662
Mailing Address - Country:US
Mailing Address - Phone:270-789-0587
Mailing Address - Fax:270-789-2025
Practice Address - Street 1:1698 OLD LEBANON RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9662
Practice Address - Country:US
Practice Address - Phone:270-789-0587
Practice Address - Fax:270-789-2025
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28637208600000X
AL00014180208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64286370Medicaid
KY000000051158OtherANTHEM BC/BS
KY020026449OtherRR MEDICARE
KY1700387OtherUNITED HEALTH CARE
C70974Medicare UPIN
KY64286370Medicaid
KY000000051158OtherANTHEM BC/BS