Provider Demographics
NPI:1063420982
Name:STEINBRENNER, ROGER WARD (MD)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:WARD
Last Name:STEINBRENNER
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 1:181 NW BUNNELL
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-6012
Mailing Address - Country:US
Mailing Address - Phone:541-479-7568
Mailing Address - Fax:541-479-7569
Practice Address - Street 1:181 NW BUNNELL
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-6012
Practice Address - Country:US
Practice Address - Phone:541-479-7568
Practice Address - Fax:541-479-7569
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD8279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR180455Medicaid
ORR0000BDHDJBMedicare ID - Type Unspecified
OR180455Medicaid