Provider Demographics
NPI:1134158454
Name:LUDWIG, ROGER DEAN JR (DO)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:DEAN
Last Name:LUDWIG
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9621 RIDGETOP BLVD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8502
Practice Address - Country:US
Practice Address - Phone:360-782-3300
Practice Address - Fax:360-782-3450
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080156323OtherRAILROAD MEDICARE
WA8243594Medicaid
1237LUOtherREGENCE BLUESHIELD
WA136436OtherLABOR & INDUSTRIES
7181118OtherAETNA
WA8939762OtherCRIME VICTIMS COMP
BL5599470OtherDEA
WAGAB15073Medicare PIN
WAG8852204Medicare PIN
BL5599470OtherDEA
WAGAB15077Medicare PIN
WAGAB15075Medicare PIN
7181118OtherAETNA