Provider Demographics
NPI:1457406761
Name:ROMIG, BRUCE D
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:D
Last Name:ROMIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 14TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4683
Mailing Address - Country:US
Mailing Address - Phone:253-845-1962
Mailing Address - Fax:253-770-8640
Practice Address - Street 1:520 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4683
Practice Address - Country:US
Practice Address - Phone:253-845-1962
Practice Address - Fax:253-770-8640
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA14802207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7113608Medicaid
WA7113608Medicaid