Provider Demographics
NPI:1235244716
Name:ILIFF, ROGER M (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:M
Last Name:ILIFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2528
Mailing Address - Country:US
Mailing Address - Phone:916-854-6666
Mailing Address - Fax:916-854-6864
Practice Address - Street 1:12 CAMINO ENCINAS
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3304
Practice Address - Country:US
Practice Address - Phone:510-204-8180
Practice Address - Fax:925-254-0687
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG38694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G386942Medicare ID - Type Unspecified
CAA47567Medicare UPIN