Provider Demographics
NPI:1528009529
Name:SACRY, ROGER A I (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:SACRY
Suffix:I
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 1:433 S GARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-1749
Mailing Address - Country:US
Mailing Address - Phone:417-359-8646
Mailing Address - Fax:417-359-8344
Practice Address - Street 1:433 S GARRISON AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-1749
Practice Address - Country:US
Practice Address - Phone:417-359-8646
Practice Address - Fax:417-359-8344
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999134577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H11256Medicare UPIN