Healthcare Provider Details

I. General information

NPI: 1376574160
Provider Name (Legal Business Name): JEFFREY PHILIP ROGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W MOANA LN STE 300
RENO NV
89509-4980
US

IV. Provider business mailing address

745 W MOANA LN STE 300
RENO NV
89509-4980
US

V. Phone/Fax

Practice location:
  • Phone: 970-640-7000
  • Fax:
Mailing address:
  • Phone: 970-640-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number20736
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD00044507
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD00044507
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: