Provider Demographics
NPI:1255395133
Name:DANZIGER, ROGER NOLAND (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:NOLAND
Last Name:DANZIGER
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:PO BOX 14908
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34280-4908
Mailing Address - Country:US
Mailing Address - Phone:941-761-1911
Mailing Address - Fax:941-761-9223
Practice Address - Street 1:5404 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2815
Practice Address - Country:US
Practice Address - Phone:941-761-1911
Practice Address - Fax:941-761-9223
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58560207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
12324OtherMEDICARE PROVIDER NUMBER
FLE97016Medicare UPIN
FL12324Medicare PIN