Provider Demographics
NPI:1699940114
Name:ROGER L. SUR, M.D., INC.
Entity type:Organization
Organization Name:ROGER L. SUR, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:LU
Authorized Official - Last Name:SUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-694-0817
Mailing Address - Street 1:8851 CENTER DRIVE
Mailing Address - Street 2:SUITE #501
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3058
Mailing Address - Country:US
Mailing Address - Phone:619-697-2456
Mailing Address - Fax:619-697-2494
Practice Address - Street 1:8851 CENTER DRIVE
Practice Address - Street 2:SUITE #501
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3058
Practice Address - Country:US
Practice Address - Phone:619-697-2456
Practice Address - Fax:619-697-2494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80585208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932208022OtherNPI TYPE 1
I16457OtherUPIN
1932208022OtherNPI TYPE 1