Provider Demographics
NPI:1689685299
Name:STEELE, ROGER BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:BRUCE
Last Name:STEELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1250 PEACH ST
Mailing Address - Street 2:STE H
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2837
Mailing Address - Country:US
Mailing Address - Phone:805-541-1671
Mailing Address - Fax:805-549-8414
Practice Address - Street 1:1250 PEACH ST
Practice Address - Street 2:STE H
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2837
Practice Address - Country:US
Practice Address - Phone:805-541-1671
Practice Address - Fax:805-549-8414
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG20201207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40839Medicare UPIN