Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 73-61 | NM |
NPI | 1346316114 |
---|---|
Provider Name | Dr. John Stanley Romine |
First Address | Farmington, NM 87401-4022 |
Second Address | Farmington, NM 87401-4022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D43283 | (02) |