Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD00044507 | WA |
N | 207RH0002X | Hospice and Palliative Medicine | 20736 | NV |
NPI | 1376574160 |
---|---|
Provider Name | Jeffrey Philip Roger |
First Address | Reno, NV 89509-4980 |
Second Address | Reno, NV 89509-4980 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8420648 | (05) | WA |
H90383 | (02) | WA |