Provider Demographics
NPI:1235121518
Name:SOBEL, ROGER M (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:M
Last Name:SOBEL
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 1:2500 E PROSPECT RD
Mailing Address - Street 2:ORTHOPAEDIC CENTER OF THE ROCKIES
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9718
Mailing Address - Country:US
Mailing Address - Phone:970-419-0112
Mailing Address - Fax:970-493-0521
Practice Address - Street 1:2500 E PROSPECT RD
Practice Address - Street 2:ORTHOPAEDIC CENTER OF THE ROCKIES
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9718
Practice Address - Country:US
Practice Address - Phone:970-419-0112
Practice Address - Fax:970-493-0521
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20663207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01206630Medicaid
D23817Medicare UPIN
COC64008Medicare PIN