Healthcare Provider Details

I. General information

NPI: 1225562119
Provider Name (Legal Business Name): ISAIAH ROGGOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 12/21/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DIGNITY HEALTH 16337 EVERHART DR
WEED CA
96094-9400
US

IV. Provider business mailing address

16337 EVERHART DR
WEED CA
96094-9400
US

V. Phone/Fax

Practice location:
  • Phone: 805-739-3374
  • Fax:
Mailing address:
  • Phone: 530-938-2297
  • Fax: 530-938-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA160642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: