Provider Demographics
NPI:1538192364
Name:GRIDER, ROGER DEAN (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:DEAN
Last Name:GRIDER
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 1:120 E ADAMS ST
Mailing Address - Street 2:STE 4
Mailing Address - City:LAGRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-1278
Mailing Address - Country:US
Mailing Address - Phone:502-222-3281
Mailing Address - Fax:502-225-5796
Practice Address - Street 1:120 E ADAMS ST
Practice Address - Street 2:STE 4
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-1278
Practice Address - Country:US
Practice Address - Phone:502-222-3281
Practice Address - Fax:502-225-5796
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY190152085R0202X, 2085B0100X, 2085U0001X, 2085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64190150Medicaid
C73612Medicare UPIN
KY0716007Medicare ID - Type UnspecifiedCT & OPEN MRI LAGRANGE,LL
KY0696205Medicare PIN
KY64190150Medicaid
KY0943704Medicare PIN
KY0913307Medicare ID - Type UnspecifiedPERRY CO RAD.ASSOCIATES
KY0943804Medicare PIN
KY0696307Medicare PIN
KY0665508Medicare ID - Type UnspecifiedJANE TODD HOSP.RAD.ASSOC
KY0518507Medicare ID - Type UnspecifiedSO.CENTRAL KY OPEN MRI
KY00195006Medicare PIN
IN215510GMedicare ID - Type UnspecifiedPERRY CO.RAD.ASSOCIATES