Provider Demographics
NPI:1164521605
Name:FRIEDENTHAL, ROGER PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:PHILIP
Last Name:FRIEDENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3562 ROUND BARN CIR STE 320
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-0182
Mailing Address - Country:US
Mailing Address - Phone:707-578-1900
Mailing Address - Fax:707-578-1111
Practice Address - Street 1:3562 ROUND BARN CIR STE 320
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-0182
Practice Address - Country:US
Practice Address - Phone:707-578-1900
Practice Address - Fax:707-578-1111
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG9257208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA58859Medicare UPIN