Healthcare Provider Details

I. General information

NPI: 1942245782
Provider Name (Legal Business Name): ROGER FELIX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INNOVAGE GREATER NEW MEXICO PACE 904 LAS LOMAS RD. NE, SUITE A
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

8950 E LOWRY BLVD
DENVER CO
80230-7030
US

V. Phone/Fax

Practice location:
  • Phone: 505-924-2650
  • Fax:
Mailing address:
  • Phone: 303-912-7193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94-241
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: