Provider Demographics
NPI:1235137845
Name:HARVEY, ROGER L (DO)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:L
Last Name:HARVEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1221 PLEASANT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1423
Mailing Address - Country:US
Mailing Address - Phone:515-241-4200
Mailing Address - Fax:515-241-4083
Practice Address - Street 1:1221 PLEASANT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1423
Practice Address - Country:US
Practice Address - Phone:515-241-4200
Practice Address - Fax:515-241-4083
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA3480207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1235137845Medicaid
IA440004045OtherRR MEDICARE
IA0276410Medicaid
IA0276410Medicaid
IAI8416Medicare PIN