Basic Information
| Provider Information | |||||||||
| NPI: | 1003862632 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROGOFF | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1760 E RIVER RD | ||||||||
| Address2: | 350 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857185999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205197720 | ||||||||
| FaxNumber: | 5205195181 | ||||||||
| Practice Location | |||||||||
| Address1: | 2625 N CRAYCROFT RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857122254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203244214 | ||||||||
| FaxNumber: | 5203242680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 11/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 104586 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 235706 | 05 | AZ | MEDICAID |