Provider Demographics
NPI:1124218169
Name:ERNEST, ROGER CHARLES (DO)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:CHARLES
Last Name:ERNEST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 WICKER ST STE B
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4168
Mailing Address - Country:US
Mailing Address - Phone:919-775-3321
Mailing Address - Fax:
Practice Address - Street 1:709 WICKER ST STE B
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4168
Practice Address - Country:US
Practice Address - Phone:919-332-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01278208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907494Medicaid
NC1453HOtherBCBS
NCP00676235OtherRAILROAD MEDICARE
NCP00676235OtherRAILROAD MEDICARE