Provider Demographics
NPI:1467400101
Name:SHEFFIELD, ROGER W (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:W
Last Name:SHEFFIELD
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 1:10488 EDINBURGH DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9584
Mailing Address - Country:US
Mailing Address - Phone:801-358-5941
Mailing Address - Fax:
Practice Address - Street 1:10488 N EDINBURGH DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-9584
Practice Address - Country:US
Practice Address - Phone:801-358-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT171935-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00086491OtherRAILROAD
UT07889Medicaid
UT$$$$$$$$$OtherCHAMPUS
UT07889Medicaid
UT006294019Medicare PIN
UTP00086491OtherRAILROAD
UTD07557Medicare UPIN