Basic Information
| Provider Information | |||||||||
| NPI: | 1780625525 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROGER ROGALSKI MD CHTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2874 N CARSON ST | ||||||||
| Address2: | #105 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897060177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758419991 | ||||||||
| FaxNumber: | 7758419485 | ||||||||
| Practice Location | |||||||||
| Address1: | 2874 N CARSON ST | ||||||||
| Address2: | #105 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897060177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758419991 | ||||||||
| FaxNumber: | 7758419485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 12/18/2007 | ||||||||
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| AuthorizedOfficialLastName: | ROGALSKI | ||||||||
| AuthorizedOfficialFirstName: | ROGER | ||||||||
| AuthorizedOfficialMiddleName: | PAUL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRES SEC ETC | ||||||||
| AuthorizedOfficialTelephone: | 7758419991 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 6391 | NV | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XX0005X | G71822 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | G71822 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 6391 | NV | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00G718220 | 01 | CA | CALIF MEDI-CAL ID | OTHER |