Individual
DR. ROGER SEBASTIAN SHINNERL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
305 W JACKSON ST STE 206, CARBONDALE, IL 62901-1474
(618) 457-3031
(618) 457-3032
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
01063822A
IN
2086S0129X
Vascular Surgery Physician
Primary
036166938
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00001666778
BCBS
IN
01
—
01063822A
STATE LICENSE
IN
01
—
01063822B
STATE CSR
IN
05
—
300063165
—
IN
05
—
7100035620
—
KY
Enumeration date
06/01/2007
Last updated
05/08/2025
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