Provider Demographics
NPI:1922070572
Name:BISSON, ROGER URBAIN (MD, MPH)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:URBAIN
Last Name:BISSON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 WINDCHIME WAY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2547
Mailing Address - Country:US
Mailing Address - Phone:850-435-9604
Mailing Address - Fax:
Practice Address - Street 1:15473 BROAD OAKS RD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-2573
Practice Address - Country:US
Practice Address - Phone:619-922-8197
Practice Address - Fax:619-438-0107
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG535032083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine