Provider Demographics
NPI:1699090639
Name:ROGER, ALFONSO CORRAL (MD)
Entity type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:CORRAL
Last Name:ROGER
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 1:326 SUNDANCE CIR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-3218
Mailing Address - Country:US
Mailing Address - Phone:626-488-3756
Mailing Address - Fax:
Practice Address - Street 1:326 SUNDANCE CIR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-3218
Practice Address - Country:US
Practice Address - Phone:626-488-3756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32854207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine