Healthcare Provider Details

I. General information

NPI: 1568429280
Provider Name (Legal Business Name): ROGER ALLEN ESPER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2928 PEACH ST
ERIE PA
16508-1843
US

IV. Provider business mailing address

2928 PEACH ST
ERIE PA
16508-1843
US

V. Phone/Fax

Practice location:
  • Phone: 814-453-6229
  • Fax: 814-456-3731
Mailing address:
  • Phone: 814-453-6229
  • Fax: 814-456-3731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS003648L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: