MEDICARE: ROGER M SIFUENTES MD PA

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

General Provider Information

NPI Number	:	1861467862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGER M SIFUENTES MD PA

Provider Business Mailing Address
First Line	:	PO BOX 6396
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78466-6396
Country	:	US
Telephone Number	:	361-387-9496
Fax Number	:	361-387-8379

Provider Business Practice Location Address
First Line	:	13701 NORTHWEST BLVD
Second Line	:	#A
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78410-5127
Country	:	US
Telephone Number	:	361-387-9496
Fax Number	:	361-387-8379

Authorized Official
Title or Position	:	OWNER
Name	:	ROGER M SIFUENTES
Credential	:	MD
Telephone Number	:	361-387-9496

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	05/02/2013

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