Provider Demographics
NPI:1306835335
Name:ROGER, ALFREDO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:
Last Name:ROGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALFREDO
Other - Middle Name:
Other - Last Name:ROGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:164 CALLE WESER
Mailing Address - Street 2:RIO PIEDRAS HGHTS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3202
Mailing Address - Country:US
Mailing Address - Phone:787-758-0972
Mailing Address - Fax:
Practice Address - Street 1:164 CALLE WESER
Practice Address - Street 2:RIO PIEDRAS HGHTS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3202
Practice Address - Country:US
Practice Address - Phone:787-758-0972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15907208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice