Provider Demographics
NPI:1407140957
Name:DIKDAN, ROGER GEORGES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:GEORGES
Last Name:DIKDAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1111 E MCDOWELL RD
Mailing Address - Street 2:LOWER LEVEL 2
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2612
Mailing Address - Country:US
Mailing Address - Phone:602-839-2296
Mailing Address - Fax:602-839-2084
Practice Address - Street 1:1111 E MCDOWELL RD
Practice Address - Street 2:LOWER LEVEL 2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2612
Practice Address - Country:US
Practice Address - Phone:602-839-2296
Practice Address - Fax:602-839-2084
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2019-12-16
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Provider Licenses
StateLicense IDTaxonomies
AZR72644207R00000X
TXR5539208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine