ROGER BRUCE MORTIMER (NPI# 1871601468) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871601468 |
| Entity Type | Individual |
| Full Name | ROGER BRUCE MORTIMER |
| Credential | MD |
| Practice Address |
290 N Wayte Ln Fresno CA 93701-2124 |
| Mailing Address |
2625 E Divisadero St Fresno CA 93721-1431 |
| Practice Telephone | 8663426012 |
| Mailing Telephone | 5594432682 |
| Mailing Fax Number | 5594432681 |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2020-01-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | A51178 | CA | Allopathic & Osteopathic Physicians |
| N | 207QH0002X |
Family Medicine Specialization: Hospice and Palliative Medicine |
A51178 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00A511780 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2823 Fresno St, Fresno, CA 937211324 | 5594996450 |
| Street Address |
290 N WAYTE LN |
| City | FRESNO |
| State | CA |
| Zip Code | 93701-2124 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780680611 | Irene R Sanchez | Nurse Practitioner | 290 N Wayte Ln, Fresno, CA 93701-2124 | 2005-06-24 |
| 1033730593 | Ashley Robbins | Student in an Organized Health Care Education/Training Program | 290 N Wayte Ln, Fresno, CA 93701-2124 | 2020-05-06 |
| 1639790298 | Benjamin Koppel | Student in an Organized Health Care Education/Training Program | 290 N Wayte Ln, Fresno, CA 93701-2124 | 2020-05-05 |
| 1770103111 | Weijian Genry Lung | Student in an Organized Health Care Education/Training Program | 290 N Wayte Ln, Fresno, CA 93701-2124 | 2020-04-24 |
| 1588284350 | Claudia Garcia | Student in an Organized Health Care Education/Training Program | 290 N Wayte Ln, Fresno, CA 93701-2124 | 2020-04-22 |
| 1114553831 | Scott Matthew Evans | Pharmacist | 290 N Wayte Ln, Pharmacy 1st Floor, Suite 1500, Fresno, CA 93701-2124 | 2020-03-13 |
| 1225546575 | Family Healthcare Network | Clinic/Center | 290 N Wayte Ln, Fresno, CA 93701-2124 | 2018-01-19 |
| 1366969990 | Leanne Wakefield | Social Worker | 290 N Wayte Ln, Fresno, CA 93701-2124 | 2017-08-24 |
| 1881129690 | Leeann Toshie Sakamoto Cunningham | Registered Nurse | 290 N Wayte Ln, Fresno, CA 93701-2124 | 2017-04-29 |
| 1134653017 | Janette Chung | Student in an Organized Health Care Education/Training Program | 290 N Wayte Ln, Suite 2500, Fresno, CA 93701-2124 | 2017-04-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134740244 | Tamara Sue Stanic | Registered Nurse | 215 N. Fresno Street, Suite 370, Fresno, CA 93701 | 2020-04-29 |
| 1144849829 | Katelyn Nicole Van Leir | Student in an Organized Health Care Education/Training Program | Surabian Dental Care Center - Suite 2500, 290 N. Wayte Lane, Fresno, CA 93701 | 2020-04-13 |
| 1003445693 | Michelle Edwardson | Registered Nurse | 215 North Fresno Street, Suite 370, Fresno, CA 93701 | 2020-04-06 |
| 1184253924 | Patricia Calderon | Registered Nurse | 215 N. Fresno Street, Suite 230, Fresno, CA 93701 | 2020-04-03 |
| 1922637032 | Leticia Lopez | Registered Nurse | 215 N. Fresno Street, Suite 230, Fresno, CA 93701 | 2020-04-02 |
| 1275026585 | Yesenia Gonzalez | Nurse Practitioner | 311 Abby Street, Fresno, CA 93701 | 2018-06-11 |
| 1710474606 | Amanda Juarez | Dietitian, Registered | 215 N Fresno, Suite 370, Fresno, CA 93701 | 2018-04-17 |
| 1235650391 | Plastic Surgery Partners of Fresno Inc | Plastic Surgery | 215 N Fresno St, Ste 490, Fresno, CA 93701 | 2017-06-29 |
| 1205369790 | Amy Alagh | Student in an Organized Health Care Education/Training Program | 155 N Fresno Street, Fresno, CA 93701 | 2017-04-11 |
| 1922462159 | Henry Matthew Dunn | Student in an Organized Health Care Education/Training Program | Ucsf Fresno, 155 N. Fresno St., Department of Orthopaedic Surgery, Fresno, CA 93701 | 2016-04-13 |
| Find all providers in zip 93701 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912516253 | Lindsay Jackson-tito | Family Medicine | 3066 E Tenaya Way, Fresno, CA 93710-5944 | 2020-07-22 |
| 1982223228 | California Surgical Medical Clinics Inc. | Family Medicine | 1050 E Perrin Ave Ste 103, Fresno, CA 93720-5032 | 2020-04-15 |
| 1851925192 | One On One Medical Care | Family Medicine | 5468 W Athens Ave, Fresno, CA 93722-2100 | 2020-02-25 |
| 1760021380 | Kawana Idali Chester | Family Medicine | 5765 N Fresno St Ste 105, Fresno, CA 93710-6092 | 2019-12-30 |
| 1356860332 | Molly Alreichan Bachir | Family Medicine | 9526 N Winery Ave, Fresno, CA 93720-4600 | 2017-09-11 |
| 1568991990 | Kevin Kaleka | Family Medicine | 1110 N Blackstone Ave, Fresno, CA 93701-1016 | 2017-06-08 |
| 1326495078 | Nirpaul Singh Bains | Family Medicine | 3875 W Beechwood Ave, Fresno, CA 93711-0795 | 2016-05-23 |
| 1497147664 | Bautista Medical Group Inc | Family Medicine | 5339 E Kings Canyon Rd, Fresno, CA 93727-4527 | 2015-02-25 |
| 1548673239 | Cara Mcananey | Family Medicine | 290 N Wayte Ln Ste 1800, Fresno, CA 93701-2124 | 2014-06-10 |
| 1861805814 | John Ted Djabrayan | Family Medicine | 4711 W Ashlan Ave, Fresno, CA 93722-4307 | 2014-06-07 |
| Find all providers in FRESNO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.