Provider Demographics
NPI:1114090669
Name:LIND, ROGER C (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:C
Last Name:LIND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23388 MULHOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2733
Mailing Address - Country:US
Mailing Address - Phone:661-284-3100
Mailing Address - Fax:661-290-3310
Practice Address - Street 1:23388 MULHOLLAND DR
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2733
Practice Address - Country:US
Practice Address - Phone:661-284-3100
Practice Address - Fax:661-290-3310
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG42548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG42548FMedicare ID - Type Unspecified
CAA49014Medicare UPIN
CAWG42548HMedicare ID - Type Unspecified
CAWG42548IMedicare ID - Type Unspecified
CAWG42548EMedicare ID - Type Unspecified
CAWG42548GMedicare ID - Type Unspecified