Provider Demographics
NPI:1861467862
Name:ROGER M SIFUENTES MD PA
Entity Type:Organization
Organization Name:ROGER M SIFUENTES MD PA
Other - Org Name:PROFESSIONAL ASSOCIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIFUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-387-9496
Mailing Address - Street 1:PO BOX 6396
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-6396
Mailing Address - Country:US
Mailing Address - Phone:361-387-9496
Mailing Address - Fax:361-387-8379
Practice Address - Street 1:13701 NORTHWEST BLVD
Practice Address - Street 2:#A
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5127
Practice Address - Country:US
Practice Address - Phone:361-387-9496
Practice Address - Fax:361-387-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00744WMedicare PIN