Healthcare Provider Details

I. General information

NPI: 1215954037
Provider Name (Legal Business Name): ROGER LEWIS GELPERIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1382 HUTCHERSON LN
ELIZABETHTOWN KY
42701-6999
US

IV. Provider business mailing address

1382 HUTCHERSON LN
ELIZABETHTOWN KY
42701-6999
US

V. Phone/Fax

Practice location:
  • Phone: 915-491-4575
  • Fax: 270-735-9311
Mailing address:
  • Phone: 915-491-4575
  • Fax: 270-735-9311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number03736
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: