Provider Demographics
NPI:1922215953
Name:ROGER VOGELFANGER
Entity Type:Organization
Organization Name:ROGER VOGELFANGER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGELFANGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-767-1136
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 630B
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-767-1136
Mailing Address - Fax:901-767-0476
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 630B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-767-1136
Practice Address - Fax:901-767-0476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW42351041C0700X
TNLSW9651041C0700X
TNMD82312084P0800X, 2084P0804X
TNMD397942084P0800X, 2084P0804X
TNMD401132084P0800X
TNAPN7497363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3724233Medicaid
TN3925579Medicaid
TN3925579Medicare ID - Type UnspecifiedGROUP NUMBER
TN3925579Medicaid