Provider Demographics
NPI:1447934260
Name:ROMINE, REGAN BURCHAM
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:BURCHAM
Last Name:ROMINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REGAN
Other - Middle Name:MACKENZIE
Other - Last Name:BURCHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 WOODBROOK DR APT D61
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2677
Mailing Address - Country:US
Mailing Address - Phone:256-612-1171
Mailing Address - Fax:
Practice Address - Street 1:1720 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1816
Practice Address - Country:US
Practice Address - Phone:205-934-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant