Provider Demographics
NPI:1699915728
Name:ROGER B. STEELE M.D., INX
Entity type:Organization
Organization Name:ROGER B. STEELE M.D., INX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-541-1671
Mailing Address - Street 1:1250 PEACH ST
Mailing Address - Street 2:STE H
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2837
Mailing Address - Country:US
Mailing Address - Phone:805-541-1671
Mailing Address - Fax:805-549-8414
Practice Address - Street 1:1250 PEACH ST
Practice Address - Street 2:STE H
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2837
Practice Address - Country:US
Practice Address - Phone:805-541-1671
Practice Address - Fax:805-549-8414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20101207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G201010Medicaid
G20101Medicare PIN
A40839Medicare UPIN