Basic Information
| Provider Information | |||||||||
| NPI: | 1972591782 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMALLIGAN | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 WALLACE BLVD | ||||||||
| Address2: | ATTN: CREDENTIALING DEPT. | ||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791061708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063545585 | ||||||||
| FaxNumber: | 8063564673 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 S COULTER ST | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791061786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063545660 | ||||||||
| FaxNumber: | 8063545717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 04/06/2011 | ||||||||
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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 | 207R00000X | MD21385 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 21385 | TN | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | N4758 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | N4758 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 205346403 | 01 | TX | MEDICAID - CSHCN | OTHER | 40572889 | 05 | NM | MEDICAID | 4086850 | 05 | TN | MEDICAID | 200263280 A | 05 | OK | MEDICAID | 205346401 | 05 | TX | MEDICAID | 205346402 | 05 | TX | MEDICAID |