MEDICARE: DR. ROGER PETER THEODORE DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	000753	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	480025693	OTHER		RAILROAD MEDICARE
3	480018494	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154398402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER PETER THEODORE DPM

Provider Business Mailing Address
First Line	:	841 MULBERRY ST
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31201
Country	:	US
Telephone Number	:	478-741-1192
Fax Number	:	478-741-0029

Provider Business Practice Location Address
First Line	:	407 BARRINGTON PT
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31220-8754
Country	:	US
Telephone Number	:	478-390-2178
Fax Number	:	478-471-0104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	08/22/2024

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