Healthcare Provider Details

I. General information

NPI: 1003862632
Provider Name (Legal Business Name): EDWARD E ROGOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 N CRAYCROFT RD STE 100
TUCSON AZ
85712-2254
US

IV. Provider business mailing address

1760 E RIVER RD 350
TUCSON AZ
85718-5999
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-4214
  • Fax: 520-324-2680
Mailing address:
  • Phone: 520-519-7720
  • Fax: 520-519-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number104586
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: