Basic Information
| Provider Information | |||||||||
| NPI: | 1457302887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGALSKI | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 973 MICA DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897057255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757836190 | ||||||||
| FaxNumber: | 7757836191 | ||||||||
| Practice Location | |||||||||
| Address1: | 973 MICA DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897057255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757836190 | ||||||||
| FaxNumber: | 7757836191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 06/09/2011 | ||||||||
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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 | 207X00000X | G71822 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 6391 | NV | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | G71822 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XX0005X | 6391 | NV | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 002003047 | 05 | NV | MEDICAID | 002003047 | 01 | NV | MEDICAID FIRST HEALTH SRV | OTHER | 00G718220 | 05 | CA | MEDICAID |