Provider Demographics
NPI:1376505321
Name:MCGEE, ROGER DALE (IDC)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:DALE
Last Name:MCGEE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 CHESTERFIELD LOOP
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-6668
Mailing Address - Country:US
Mailing Address - Phone:757-816-5585
Mailing Address - Fax:
Practice Address - Street 1:2120 CHESTERFIELD LOOP
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-6668
Practice Address - Country:US
Practice Address - Phone:757-314-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman