Provider Demographics
NPI:1386637486
Name:PAUL, ROGER D (AUD, FAAA)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:PAUL
Suffix:
Gender:M
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10255 S 300 W
Mailing Address - Street 2:
Mailing Address - City:UNION MILLS
Mailing Address - State:IN
Mailing Address - Zip Code:46382-9651
Mailing Address - Country:US
Mailing Address - Phone:219-767-2884
Mailing Address - Fax:
Practice Address - Street 1:10255 S 300 W
Practice Address - Street 2:
Practice Address - City:UNION MILLS
Practice Address - State:IN
Practice Address - Zip Code:46382-9651
Practice Address - Country:US
Practice Address - Phone:219-767-2884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001115231H00000X
231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter