Provider Demographics
NPI:1225562119
Name:ROGGOW, ISAIAH (MD)
Entity Type:Individual
Prefix:
First Name:ISAIAH
Middle Name:
Last Name:ROGGOW
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 1:16337 EVERHART DR
Mailing Address - Street 2:
Mailing Address - City:WEED
Mailing Address - State:CA
Mailing Address - Zip Code:96094-9400
Mailing Address - Country:US
Mailing Address - Phone:530-938-2297
Mailing Address - Fax:530-938-0494
Practice Address - Street 1:DIGNITY HEALTH 16337 EVERHART DR
Practice Address - Street 2:
Practice Address - City:WEED
Practice Address - State:CA
Practice Address - Zip Code:96094-9400
Practice Address - Country:US
Practice Address - Phone:805-739-3374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA160642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty