Healthcare Provider Details

I. General information

NPI: 1619965449
Provider Name (Legal Business Name): ROGER S PALUTSIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S ARCH AVE
ALLIANCE OH
44601-4202
US

IV. Provider business mailing address

1401 S ARCH AVE
ALLIANCE OH
44601-4202
US

V. Phone/Fax

Practice location:
  • Phone: 330-821-0201
  • Fax: 330-821-1924
Mailing address:
  • Phone: 330-821-0201
  • Fax: 330-821-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35063106
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: