Provider Demographics
NPI:1700271988
Name:BIDONDO GIL, ROGER ERNESTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:ERNESTO
Last Name:BIDONDO GIL
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 1:9999 KENWORTHY ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4412
Mailing Address - Country:US
Mailing Address - Phone:915-298-3434
Mailing Address - Fax:915-751-7257
Practice Address - Street 1:9999 KENWORTHY ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4412
Practice Address - Country:US
Practice Address - Phone:915-298-3434
Practice Address - Fax:915-751-7257
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294827207R00000X
TXR9471207RG0300X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program