Active NPI
Roger L Greenlaw, M.D.
- Gastroenterology Physician
- Rockford, IL
National Provider Identifier
1699761890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 36051426
- Practice address
- 401 Roxbury Rd
Rockford, IL 61107-5075 - Phone
- (815) 397-7340
- Fax
- (815) 397-2156
- NPI assigned
- Sep 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 36051426 | IL | Primary |
Addresses
Primary practice location
401 Roxbury Rd
Rockford, IL 61107-5075
Mailing address
401 Roxbury Rd
Rockford, IL 61107-5075
Phone (815) 397-7340
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36051426 | IL | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189036800000",
"number": "1699761890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 ROXBURY RD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611075075",
"telephone_number": "815-397-7340",
"fax_number": "815-397-2156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 ROXBURY RD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611075075",
"telephone_number": "815-397-7340",
"fax_number": "815-397-2156"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREENLAW",
"first_name": "ROGER",
"middle_name": "L",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-22",
"last_updated": "2007-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "IL",
"license": "36051426",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.