1457302887 NPI number — DR. ROGER PAUL ROGALSKI MD

Table of content: DR. ROGER PAUL ROGALSKI MD (NPI 1457302887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457302887 NPI number — DR. ROGER PAUL ROGALSKI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGALSKI
Provider First Name:
ROGER
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
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:
1457302887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
973 MICA DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
CARSON CITY
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89705-7255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-783-6190
Provider Business Mailing Address Fax Number:
775-783-6191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
973 MICA DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CARSON CITY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89705-7255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-783-6190
Provider Business Practice Location Address Fax Number:
775-783-6191
Provider Enumeration Date:
05/12/2006

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: 207X00000X , with the licence number:  G71822 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 6391 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XX0005X , with the licence number: G71822 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , with the licence number: 6391 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 002003047 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002003047 . This is a "MEDICAID FIRST HEALTH SRV" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 00G718220 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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