MEDICARE: ROGER SUR MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	166464	CA

General Provider Information

NPI Number	:	1902300221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER SUR MD

Provider Business Mailing Address
First Line	:	4445 MAGNOLIA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92501-4135
Country	:	US
Telephone Number	:	951-836-0316
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 SAN MIGUEL DR STE 300
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7820
Country	:	US
Telephone Number	:	949-557-0830
Fax Number	:

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

Provider Enumeration Date	:	03/21/2018
Last Update Date	:	09/26/2023

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Directions to “ ROGER SUR MD” Practice Location

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