Provider Demographics
NPI:1871607291
Name:ENG, ROGER S (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:S
Last Name:ENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26750
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-6750
Mailing Address - Country:US
Mailing Address - Phone:559-455-4053
Mailing Address - Fax:770-666-9102
Practice Address - Street 1:845 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4851
Practice Address - Country:US
Practice Address - Phone:415-677-2320
Practice Address - Fax:770-666-9102
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG754712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G754710Medicaid
CA00G754710Medicaid
CA00G794710Medicare PIN
CAG59868Medicare UPIN