Provider Demographics
NPI:1932132669
Name:NUNEZ, ROGER L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:L
Last Name:NUNEZ
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 1:2701 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-5708
Mailing Address - Country:US
Mailing Address - Phone:601-693-0118
Mailing Address - Fax:601-483-8803
Practice Address - Street 1:199 HIGHWAY 15 S STE D
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-6608
Practice Address - Country:US
Practice Address - Phone:662-779-1175
Practice Address - Fax:601-553-8175
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120943Medicaid
MS080003174Medicare PIN