Individual
ROGER MACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2024 S 6TH ST, BRAINERD, MN 56401-4529
(218) 828-7100
Mailing address
523 N 3RD ST, BRAINERD, MN 56401-3054
(218) 828-7100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32187
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055873700
—
MN
Enumeration date
12/02/2005
Last updated
01/08/2016
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