Provider Demographics
NPI:1104284991
Name:ROGER A. MARRERO, M.D. DBA OVIEDO PRIMARY CARE
Entity type:Organization
Organization Name:ROGER A. MARRERO, M.D. DBA OVIEDO PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-359-5098
Mailing Address - Street 1:1410 W BROADWAY ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6456
Mailing Address - Country:US
Mailing Address - Phone:407-359-5098
Mailing Address - Fax:407-365-5119
Practice Address - Street 1:1410 W BROADWAY ST
Practice Address - Street 2:SUITE 108
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6456
Practice Address - Country:US
Practice Address - Phone:407-359-5098
Practice Address - Fax:407-365-5119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057713261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB34842Medicare UPIN