Provider Demographics
NPI:1811965049
Name:BANGS, ROGER GUY (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:GUY
Last Name:BANGS
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:
Practice Address - Street 1:5177 MCCARTY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8764
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-8027
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039163A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000191064OtherANTHEM PROVIDER NUMBER
IN10824741OtherCAQH NUMBER
IN9008271OtherPHCS PID NUMBER
IN100232880Medicaid
IN000000191064OtherANTHEM PROVIDER NUMBER
IN815450LMedicare PIN
IN9008271OtherPHCS PID NUMBER
IN020038427Medicare PIN
IN142080NNNMedicare PIN