Provider Demographics
NPI:1144396847
Name:PUMPHREY, ROGER D (MD)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:D
Last Name:PUMPHREY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 E ST URAIN
Mailing Address - Street 2:STE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903
Mailing Address - Country:US
Mailing Address - Phone:719-635-8124
Mailing Address - Fax:719-633-9705
Practice Address - Street 1:100 E SAINT VRAIN ST
Practice Address - Street 2:STE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4940
Practice Address - Country:US
Practice Address - Phone:719-635-8124
Practice Address - Fax:719-633-9705
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO411232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A56056Medicare UPIN