MEDICARE: ALFONSO E ROGGIERO P.A.-C.

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	363A00000X	Physician Assistant	1368	AZ

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	:	1558318295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFONSO E ROGGIERO P.A.-C.

Provider Business Mailing Address
First Line	:	11045 N 19TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4816
Country	:	US
Telephone Number	:	602-944-4474
Fax Number	:	602-944-0194

Provider Business Practice Location Address
First Line	:	11045 N 19TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4816
Country	:	US
Telephone Number	:	602-944-4474
Fax Number	:	602-943-7829

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	08/19/2008

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Directions to “ ALFONSO E ROGGIERO P.A.-C.” Practice Location

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