Provider Demographics
NPI:1649219676
Name:LONGMIRE, ROMARIUS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMARIUS
Middle Name:
Last Name:LONGMIRE
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 1:1976 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36615-1114
Mailing Address - Country:US
Mailing Address - Phone:251-660-5910
Mailing Address - Fax:251-660-5911
Practice Address - Street 1:1976 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36615-1114
Practice Address - Country:US
Practice Address - Phone:251-660-5910
Practice Address - Fax:251-660-5911
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.386212083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN