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NPI Code Detail

MEDICARE: DR. ROGER DALE PAIGE PH.D.

MEDICARE: DR. ROGER DALE PAIGE PH.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
1103TC0700XClinical Psychologist116659MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770582280
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROGER DALE PAIGE PH.D.
Provider Business Mailing Address
First Line : 1230 N DUQUESNE RD
Second Line :
City : JOPLIN
State : MO
Zip : 64801-1509
Country : US
Telephone Number : 417-782-1443
Fax Number : 417-782-3240
Provider Business Practice Location Address
First Line : 1230 N DUQUESNE RD
Second Line :
City : JOPLIN
State : MO
Zip : 64801-1509
Country : US
Telephone Number : 417-782-1443
Fax Number : 417-782-3240
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 04/22/2014

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