MEDICARE: ROGER PITZEN 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	207Q00000X	Family Medicine Physician	00G370340	CA

General Provider Information

NPI Number	:	1396742524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER PITZEN M.D.

Provider Business Mailing Address
First Line	:	555 PETALUMA AVE
Second Line	:	#A
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4224
Country	:	US
Telephone Number	:	707-823-3210
Fax Number	:	707-823-1710

Provider Business Practice Location Address
First Line	:	555 PETALUMA AVE
Second Line	:	#A
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4224
Country	:	US
Telephone Number	:	707-823-3210
Fax Number	:	707-823-1710

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	04/13/2012

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