Individual
MR. ROGER J BIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
21107 DONAHOO RD, TONGANOXIE, KS 66086-4153
(913) 742-4084
(913) 742-4086
Mailing address
21107 DONAHOO RD, PO BOX 996, TONGANOXIE, KS 66086-4153
(913) 742-4084
(913) 742-4086
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
128639
MO
363L00000X
Nurse Practitioner
Primary
44815
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100347550A
—
KS
01
—
26279011
BC/BS
—
01
—
500008410
RAILROAD MEDICARE
—
Enumeration date
05/17/2006
Last updated
01/07/2011
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