Basic Information
| Provider Information | |||||||||
| NPI: | 1700271988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIDONDO GIL | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | ERNESTO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9999 KENWORTHY ST | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799244412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152983434 | ||||||||
| FaxNumber: | 9157517257 | ||||||||
| Practice Location | |||||||||
| Address1: | 9999 KENWORTHY ST | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799244412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152983434 | ||||||||
| FaxNumber: | 9157517257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2015 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 294827 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | R9471 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | R9471 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.