Provider Demographics
NPI:1003860586
Name:ROGER L. FIFE, M.D., INC
Entity Type:Organization
Organization Name:ROGER L. FIFE, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:FIFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-723-9879
Mailing Address - Street 1:780 WEST OLIVE AVENUE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2437
Mailing Address - Country:US
Mailing Address - Phone:209-723-9879
Mailing Address - Fax:209-384-9027
Practice Address - Street 1:780 WEST OLIVE AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2437
Practice Address - Country:US
Practice Address - Phone:209-723-9879
Practice Address - Fax:209-384-9027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A341050Medicaid
CAA27373Medicare UPIN
CA00A341050Medicaid