Healthcare Provider Details

I. General information

NPI: 1043137003
Provider Name (Legal Business Name): ROGER LEE TREMBLY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 S 2ND ST
MONTROSE CO
81401-4244
US

IV. Provider business mailing address

28342 ROAD T.5
DOLORES CO
81323-9395
US

V. Phone/Fax

Practice location:
  • Phone: 970-901-5271
  • Fax:
Mailing address:
  • Phone: 970-739-4168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09933452
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: