Healthcare Provider Details

I. General information

NPI: 1003959677
Provider Name (Legal Business Name): DOUGLAS J. ROGER M.D.,INC., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR STE W201
PALM SPRINGS CA
92262-4876
US

IV. Provider business mailing address

PO BOX 2110
PALM SPRINGS CA
92263-2110
US

V. Phone/Fax

Practice location:
  • Phone: 760-416-4511
  • Fax: 760-416-4512
Mailing address:
  • Phone: 760-416-4511
  • Fax: 760-416-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG77670
License Number StateCA

VIII. Authorized Official

Name: DR. DOUGLAS J. ROGER
Title or Position: PRESIDENT
Credential: MD
Phone: 760-416-4511