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NPI Code Detail

MEDICARE: MR. ROGER DALE MCGEE IDC

MEDICARE:  MR. ROGER DALE MCGEE  IDC
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
11710I1002XIndependent Duty Corpsman

General Provider Information

NPI Number : 1376505321
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROGER DALE MCGEE IDC
Provider Business Mailing Address
First Line : 2120 CHESTERFIELD LOOP
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23323-6668
Country : US
Telephone Number : 757-816-5585
Fax Number :
Provider Business Practice Location Address
First Line : 2120 CHESTERFIELD LOOP
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23323-6668
Country : US
Telephone Number : 757-314-7493
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2006
Last Update Date : 07/08/2007

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Directions to “ MR. ROGER DALE MCGEE IDC” Practice Location

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