Provider Demographics
NPI:1588660690
Name:VITKO, ROGER J (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:J
Last Name:VITKO
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:PO BOX 3989
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-3989
Mailing Address - Country:US
Mailing Address - Phone:956-362-8767
Mailing Address - Fax:956-362-2548
Practice Address - Street 1:2603 MICHAEL ANGELO DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1417
Practice Address - Country:US
Practice Address - Phone:956-362-8767
Practice Address - Fax:956-362-2548
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1437208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131167207Medicaid
TX287957YNMFMedicare PIN
TX287957YNMFMedicare PIN
TX314368701Medicaid
TX287957YNMFMedicare PIN