Provider Demographics
NPI:1821094780
Name:HUCEK, ROGER JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:JAMES
Last Name:HUCEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5620 W THUNDERBIRD RD
Mailing Address - Street 2:STE E1
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4651
Mailing Address - Country:US
Mailing Address - Phone:602-547-1623
Mailing Address - Fax:602-547-1767
Practice Address - Street 1:5620 W THUNDERBIRD RD
Practice Address - Street 2:STE E1
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4651
Practice Address - Country:US
Practice Address - Phone:602-547-1623
Practice Address - Fax:602-547-1767
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19766208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ044967Medicaid
AZC02162Medicare UPIN
AZ71350Medicare ID - Type Unspecified