1063420982 NPI number — MR. ROGER WARD STEINBRENNER MD

Table of content: (NPI 1003937319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063420982 NPI number — MR. ROGER WARD STEINBRENNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEINBRENNER
Provider First Name:
ROGER
Provider Middle Name:
WARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063420982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
181 NW BUNNELL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANTS PASS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97526-6012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-479-7568
Provider Business Mailing Address Fax Number:
541-479-7569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 NW BUNNELL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANTS PASS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97526-6012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-479-7568
Provider Business Practice Location Address Fax Number:
541-479-7569
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD8279 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 180455 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com