Provider Demographics
NPI:1801823612
Name:EWING, ROGER JOE (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:JOE
Last Name:EWING
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 2027
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-2027
Mailing Address - Country:US
Mailing Address - Phone:319-339-3541
Mailing Address - Fax:319-358-2737
Practice Address - Street 1:540 E JEFFERSON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2477
Practice Address - Country:US
Practice Address - Phone:319-337-5997
Practice Address - Fax:319-358-2665
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25693207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
26078OtherBLUE CROSS BLUE SHIELD
IA2298299Medicaid
D90043Medicare UPIN
IA2298299Medicaid