Provider Demographics
NPI:1356521892
Name:ROGER J. WOLCOTT, M.D., P.A.
Entity type:Organization
Organization Name:ROGER J. WOLCOTT, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-797-2139
Mailing Address - Street 1:5902 66TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-5933
Mailing Address - Country:US
Mailing Address - Phone:806-797-2139
Mailing Address - Fax:806-797-3105
Practice Address - Street 1:5902 66TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-5933
Practice Address - Country:US
Practice Address - Phone:806-797-2139
Practice Address - Fax:806-797-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4620208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110687404Medicaid
TX172052601Medicaid
TX00028AAOtherBLUE CROSS BLUE SHIELD
TX172052601Medicaid
TX00028AAOtherBLUE CROSS BLUE SHIELD
TX172053401Medicaid
TX172052601Medicaid