Park, Roger W
Park, Roger W is an individual health care provider with primary practice located at 1000 N Oak Ave , Marshfield WI 54449-5703. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Gastroenterology, Allopathic & Osteopathic Physicians / Pediatric Gastroenterology. Allopathic & Osteopathic Physicians / Gastroenterology is his primary health care specialty. Park, Roger W can be contacted via phone (715) 387-5251.Contact Information
Primary practice address
1000 N Oak Ave
Marshfield WI 54449-5703
Phone: (715) 387-5251
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 29100 | Wisconsin |
| Allopathic & Osteopathic Physicians / Pediatric Gastroenterology | 2080P0206X | 29100 | Wisconsin |
Profile Details
| NPI number | 1174623409 |
|---|---|
| LBN Legal business name | Park, Roger W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 25th, 2006 |
| Last updated | Sep 28th, 2010 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174623409 | NPPES |
| Wisconsin | MEDICAID | 31377900 |
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