Provider Demographics
NPI:1336174242
Name:OVE, ROGER (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:OVE
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 40010
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0010
Mailing Address - Country:US
Mailing Address - Phone:251-665-8000
Mailing Address - Fax:251-665-8010
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-2558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL233292085R0001X
OH35.1257212085R0001X
TN402812085R0001X
NC2005-016532085R0001X
MS190962085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1464POtherBCBS
AL920005599OtherRAILROAD MEDICARE
AL051505829OtherBLUE CROSS
ALH16052OtherVIVA
AL000096027OtherBLUE CROSS
AL009982920Medicaid
AL051513427OtherBLUE CROSS
NC5908135Medicaid
AL000096027Medicaid
NC2073428Medicare Oscar/Certification
NC1464POtherBCBS
TN3335109Medicare ID - Type UnspecifiedAND MEDICAID
TNH16052Medicare UPIN
AL000096027Medicare ID - Type Unspecified