MEDICARE: DR. DOUGLAS JAY ROGER 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	207X00000X	Orthopaedic Surgery Physician	G77670	CA

General Provider Information

NPI Number	:	1649272337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS JAY ROGER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 960
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92263-0960
Country	:	US
Telephone Number	:	760-416-4511
Fax Number	:	760-416-4512

Provider Business Practice Location Address
First Line	:	1180 N INDIAN CANYON DR
Second Line	:	SUITE W-201
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4800
Country	:	US
Telephone Number	:	760-416-4511
Fax Number	:	760-416-4512

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/10/2014

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