Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A32404 | CA |
Y | 2080P0202X | Pediatric Cardiologist | A32404 | CA |
NPI | 1053421537 |
---|---|
Provider Name | Dr. Claude L. Roge |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94143-2204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 17/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A324040 | (05) | CA |
A26792 | (02) | CA |