Individual
GREGORY ROMANIUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9850 W ST LUKES DR, NAMPA, ID 83687-7912
(208) 205-7282
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
LL29132
SC
207Q00000X
Family Medicine Physician
Primary
M-165550
ID
207Q00000X
Family Medicine Physician
ME104586
FL
207Q00000X
Family Medicine Physician
TP818
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001196700
—
FL
Enumeration date
07/15/2006
Last updated
05/09/2022
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