Healthcare Provider Details

I. General information

NPI: 1942261904
Provider Name (Legal Business Name): ROGER DENNIS DUBER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 N 13TH AVE STE 9
UPLAND CA
91786
US

IV. Provider business mailing address

685 N 13TH AVE STE 9
UPLAND CA
91786
US

V. Phone/Fax

Practice location:
  • Phone: 909-981-8383
  • Fax: 909-920-3054
Mailing address:
  • Phone: 909-981-8383
  • Fax: 909-920-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number20A4904
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number20A4904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: