MEDICARE: DR. RICHARD NORMAN ROGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	GFE9686	CA

General Provider Information

NPI Number	:	1295009645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD NORMAN ROGER M.D.

Provider Business Mailing Address
First Line	:	39321 KERSTEN RD
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-3622
Country	:	US
Telephone Number	:	760-324-6958
Fax Number	:	760-324-9389

Provider Business Practice Location Address
First Line	:	39321 KERSTEN RD
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-3622
Country	:	US
Telephone Number	:	760-324-6958
Fax Number	:	760-324-9389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2012
Last Update Date	:	03/02/2012

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