Provider Demographics
NPI:1205276003
Name:ROMER, JEANNA (MD)
Entity type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:ROMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1200
Mailing Address - Country:US
Mailing Address - Phone:541-663-3150
Mailing Address - Fax:541-975-5111
Practice Address - Street 1:710 SUNSET DR STE E
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1200
Practice Address - Country:US
Practice Address - Phone:416-633-3150
Practice Address - Fax:541-975-5111
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD193149207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program