Roger D Pittman, P.A.C
Individual provider Active NPI Physician Assistant · Gonzales, CA
NPI 1356355291 · NPPES record last updated Jan 15, 2014
Key facts
- NPI
- 1356355291
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA18036 (CA)
- Practice address
- 133 Fourth Street
Gonzales, CA 93926-0646 - Phone
- (831) 675-3601
- Fax
- (831) 675-3966
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18036 | CA | MD | Speech-Language Pathologist |
| PA18036 | CA | MD | Physician Assistant |
| 126 | CO | MD | Advanced Practice Midwife |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Robert Bess MD, Facs Orthopaedic Surgery Inc | Past | Accepting new patients | |
| Denver Diagnostic Pain Corporation | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA18036 | CA | Yes |
Addresses
Primary practice location
133 Fourth Street
Gonzales, CA 93926-0646
Mailing address
PO Box 646
133 Fourth Street
Gonzales, CA 93926-0646
Phone (831) 675-3601
Other providers in Gonzales, CA
- Alberto Martinez
- Ocean Breeze Home Health Inc
- Dolores Pena
- Cristina D Perez
- David Leon Perez
- Alison Poandl
- Christine C Ponzio
- David M. Ramirez
- Francis Rangel Ventura
- Jesika Rodriguez
All providers in Gonzales, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.