Provider Demographics
NPI:1437164803
Name:ROVNER, SERGIO F (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:F
Last Name:ROVNER
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 1:1516 LOMALAND DR.
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935
Mailing Address - Country:US
Mailing Address - Phone:915-593-2600
Mailing Address - Fax:915-593-2609
Practice Address - Street 1:1516 LOMALAND DR.
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935
Practice Address - Country:US
Practice Address - Phone:915-593-2600
Practice Address - Fax:915-593-2609
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1037207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085780701Medicaid
TX123380101Medicaid
TX86Z993Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL#
TX00U79ZMedicare ID - Type UnspecifiedMEDICARE GROUP#
TX123380101Medicaid