Provider Demographics
NPI:1275542276
Name:RIGGENBACH, ROGER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:RIGGENBACH
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 1:5041 N 12TH AVE
Mailing Address - Street 2:COVENANT HOSPICE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8916
Mailing Address - Country:US
Mailing Address - Phone:850-433-2155
Mailing Address - Fax:850-202-0600
Practice Address - Street 1:101 HART ST
Practice Address - Street 2:COVENANT HOSPICE
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1040
Practice Address - Country:US
Practice Address - Phone:850-729-1800
Practice Address - Fax:850-729-7883
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 13765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D54924Medicare UPIN
46051ZMedicare ID - Type Unspecified