Provider Demographics
NPI:1891794285
Name:NUNN, ROGER D (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:NUNN
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 1:525 BRYAN ST
Mailing Address - Street 2:A
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2795
Mailing Address - Country:US
Mailing Address - Phone:940-382-1511
Mailing Address - Fax:
Practice Address - Street 1:525 BRYAN ST
Practice Address - Street 2:A
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2795
Practice Address - Country:US
Practice Address - Phone:940-382-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9253207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AJ099OtherBLUE CROSS BLUE SHIELD
TXP000M8804Medicaid
TX8AJ099OtherBLUE CROSS BLUE SHIELD
TXC19963Medicare UPIN