Provider Demographics
NPI:1073880365
Name:ROGELIO A. CASAMA, MD, APMC
Entity Type:Organization
Organization Name:ROGELIO A. CASAMA, MD, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:TYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-735-8382
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70429-0220
Mailing Address - Country:US
Mailing Address - Phone:985-735-8382
Mailing Address - Fax:985-735-9075
Practice Address - Street 1:2807 S COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-7915
Practice Address - Country:US
Practice Address - Phone:985-735-8382
Practice Address - Fax:985-735-9075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1106755Medicaid
LA5J487Medicare UPIN