Provider Demographics
NPI:1932336849
Name:ULRICH, ROGER WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:WESLEY
Last Name:ULRICH
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 1:11 ARLEY WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4883
Mailing Address - Country:US
Mailing Address - Phone:843-706-8690
Mailing Address - Fax:843-706-5066
Practice Address - Street 1:11 ARLEY WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4883
Practice Address - Country:US
Practice Address - Phone:843-706-8690
Practice Address - Fax:843-706-5066
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRES000Medicare UPIN