MEDICARE: DR. ROGER MICHEEL MENZE M.D.

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	207P00000X	Emergency Medicine Physician	ME68199	FL

General Provider Information

NPI Number	:	1265540413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER MICHEEL MENZE M.D.

Provider Business Mailing Address
First Line	:	4511 COQUINA DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-2210
Country	:	US
Telephone Number	:	904-563-1695
Fax Number	:

Provider Business Practice Location Address
First Line	:	MEMORIAL EMERGENCY DEPT
Second Line	:	3623 UNIVERSITY BLVD S
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216
Country	:	US
Telephone Number	:	904-399-6156
Fax Number	:

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

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	07/08/2007

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