Healthcare Provider Details

I. General information

NPI: 1568406999
Provider Name (Legal Business Name): ROGER ROGALSKI MD CHTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 NEW YORK RANCH RD
JACKSON CA
95642-9328
US

IV. Provider business mailing address

2874 N CARSON ST #105
CARSON CITY NV
89706-0177
US

V. Phone/Fax

Practice location:
  • Phone: 800-544-3955
  • Fax: 530-544-2359
Mailing address:
  • Phone: 775-841-9991
  • Fax: 775-841-9485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number6391
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number6391
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberG71822
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG71822
License Number StateCA

VIII. Authorized Official

Name: ROGER PAUL ROGALSKI
Title or Position: PRES SEC ETC
Credential: MD
Phone: 775-841-9991