Healthcare Provider Details

I. General information

NPI: 1083604417
Provider Name (Legal Business Name): ROGELIO JOHN TOBIAS NARANJA JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 E MAIN ST
FORT KENT ME
04743-1428
US

IV. Provider business mailing address

194 E MAIN ST
FORT KENT ME
04743-1428
US

V. Phone/Fax

Practice location:
  • Phone: 207-834-5912
  • Fax: 207-834-5914
Mailing address:
  • Phone: 207-834-5912
  • Fax: 207-834-5914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number015649
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: