Theodore, Roger Peter

Theodore, Roger Peter is an individual health care provider with primary practice located at 841 Mulberry St , Macon GA 31201. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Theodore, Roger Peter can be contacted via phone (478) 741-1192.

Contact Information

Primary practice address
841 Mulberry St Macon GA 31201
Phone: (478) 741-1192
Fax: (478) 741-0029
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 000753 Georgia

Profile Details

NPI number 1154398402
LBN Legal business name Theodore, Roger Peter
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 7th, 2006
Last updated May 27th, 2008 - about 16 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154398402 NPPES
Other 480018494 RAILROAD MEDICARE
MEDICAID 00655322A RAILROAD MEDICARE
Other 480025693 RAILROAD MEDICARE

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