Provider Demographics
NPI:1639402159
Name:ROGER ISLA MD INC
Entity Type:Organization
Organization Name:ROGER ISLA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:ISLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-264-6157
Mailing Address - Street 1:PO BOX 4267
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-8267
Mailing Address - Country:US
Mailing Address - Phone:304-723-6040
Mailing Address - Fax:304-723-6090
Practice Address - Street 1:4317 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-3619
Practice Address - Country:US
Practice Address - Phone:740-264-6157
Practice Address - Fax:740-264-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035903207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty