MEDICARE: DR. ROGER D SHEALY MD

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	S 7246	SC

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	:	1982639274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER D SHEALY MD

Provider Business Mailing Address
First Line	:	2224 OLD FURNACE RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29316
Country	:	US
Telephone Number	:	864-578-8720
Fax Number	:	864-599-5678

Provider Business Practice Location Address
First Line	:	2224 OLD FURNACE RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29316
Country	:	US
Telephone Number	:	864-578-8720
Fax Number	:	864-599-5678

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	11/04/2011

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