Provider Demographics
NPI:1588872873
Name:CORON, ROGER N (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:N
Last Name:CORON
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 1:10080 SW INNOVATION WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2129
Mailing Address - Country:US
Mailing Address - Phone:772-398-1800
Mailing Address - Fax:
Practice Address - Street 1:10080 SW INNOVATION WAY STE 201
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2129
Practice Address - Country:US
Practice Address - Phone:772-398-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257168207RG0100X
FLME156148207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology