MEDICARE: MR. ROGER DALE MCGEE IDC

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	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1376505321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROGER DALE MCGEE IDC

Provider Business Mailing Address
First Line	:	2120 CHESTERFIELD LOOP
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23323-6668
Country	:	US
Telephone Number	:	757-816-5585
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 CHESTERFIELD LOOP
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23323-6668
Country	:	US
Telephone Number	:	757-314-7493
Fax Number	:

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	07/08/2007

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