Provider Demographics
NPI:1104821586
Name:LE, ROGER PHU (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:PHU
Last Name:LE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MINH
Other - Middle Name:PHU
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4201 GARTH RD STE 209
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3155
Mailing Address - Country:US
Mailing Address - Phone:281-427-2000
Mailing Address - Fax:281-427-2008
Practice Address - Street 1:4201 GARTH RD STE 209
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3155
Practice Address - Country:US
Practice Address - Phone:281-427-2000
Practice Address - Fax:281-427-2008
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8280208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045829102Medicaid
TXG94298Medicare UPIN