Provider Demographics
NPI:1447362306
Name:SHELLING, ROGER HARRIS (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:HARRIS
Last Name:SHELLING
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 1:5601 N DIXIE HIGHWAY
Mailing Address - Street 2:SUITE 317
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334
Mailing Address - Country:US
Mailing Address - Phone:954-772-8207
Mailing Address - Fax:954-938-8056
Practice Address - Street 1:5601 N DIXIE HIGHWAY
Practice Address - Street 2:SUITE 317
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334
Practice Address - Country:US
Practice Address - Phone:954-772-8207
Practice Address - Fax:954-938-8056
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0035947208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL66117100Medicaid
D63059Medicare UPIN
FL66117100Medicaid