Provider Demographics
NPI:1265540413
Name:MENZE, ROGER MICHEEL (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:MICHEEL
Last Name:MENZE
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 1:4511 COQUINA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2210
Mailing Address - Country:US
Mailing Address - Phone:904-563-1695
Mailing Address - Fax:
Practice Address - Street 1:MEMORIAL EMERGENCY DEPT
Practice Address - Street 2:3623 UNIVERSITY BLVD S
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-399-6156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68199207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273712Medicare ID - Type Unspecified
FLF72368Medicare UPIN