Provider Demographics
NPI:1669447041
Name:ROMEYN, RICHARD L (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:ROMEYN
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 1:111 RIVERFRONT
Mailing Address - Street 2:STE 307
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3456
Mailing Address - Country:US
Mailing Address - Phone:507-474-9300
Mailing Address - Fax:507-474-9302
Practice Address - Street 1:111 RIVERFRONT
Practice Address - Street 2:STE 307
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3456
Practice Address - Country:US
Practice Address - Phone:507-474-9300
Practice Address - Fax:507-474-9302
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32427174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN788277700Medicaid
MNB85203Medicare UPIN
MN788277700Medicaid