Provider Demographics
NPI:1891007290
Name:STILGENBAUER, ROGER PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:PAUL
Last Name:STILGENBAUER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 3
Mailing Address - Street 2:BOX 697
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09021-9998
Mailing Address - Country:US
Mailing Address - Phone:01149638-499-3708
Mailing Address - Fax:
Practice Address - Street 1:USA MEDDAC BAVARIA
Practice Address - Street 2:CMR 411, BLDG 700, ROSE BARRACKS
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:01149966-283-4719
Practice Address - Fax:01149966-283-4721
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT31662106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000OtherUPIN