Provider Demographics
NPI:1871577338
Name:MARRERO, ROGER A (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
Last Name:MARRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1410 W BROADWAY ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6456
Mailing Address - Country:US
Mailing Address - Phone:407-359-5098
Mailing Address - Fax:407-365-5119
Practice Address - Street 1:1410 W BROADWAY ST
Practice Address - Street 2:SUITE 108
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6456
Practice Address - Country:US
Practice Address - Phone:407-359-5098
Practice Address - Fax:407-365-5119
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0057713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB34842Medicare UPIN
FL18794BMedicare ID - Type Unspecified