Provider Demographics
NPI:1295792034
Name:ROME, RICHARD STEVEN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:STEVEN
Last Name:ROME
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 1:4777 US HIGHWAY 259
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7668
Mailing Address - Country:US
Mailing Address - Phone:903-663-4800
Mailing Address - Fax:903-663-7394
Practice Address - Street 1:1011 N GALLOWAY
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2433
Practice Address - Country:US
Practice Address - Phone:214-320-7000
Practice Address - Fax:903-663-7394
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG40482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132263809Medicaid
TX132263810Medicaid
TXP00131289Medicare PIN
TX8C0070Medicare PIN
D67680Medicare UPIN
TX8J5842Medicare PIN