Healthcare Provider Details

I. General information

NPI: 1306864905
Provider Name (Legal Business Name): ROGER R PRESZLER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 BROADWAY N
FARGO ND
58122-0001
US

IV. Provider business mailing address

PO BOX 67250
LINCOLN NE
68506-7250
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-4811
  • Fax: 701-234-6979
Mailing address:
  • Phone: 402-328-2907
  • Fax: 888-965-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPAC0173
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: