Healthcare Provider Details

I. General information

NPI: 1003239187
Provider Name (Legal Business Name): UNIVERSAL ORTHOPAEDIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR SUITE W201
PALM SPRINGS CA
92262-4800
US

IV. Provider business mailing address

PO BOX 960
RANCHO MIRAGE CA
92270-0960
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG77670
License Number StateCA

VIII. Authorized Official

Name: DOUGLAS JAY ROGER
Title or Position: OWNER
Credential: MD
Phone: 760-416-4511