Provider Demographics
NPI:1538202338
Name:BELCOURT, ROGER M
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:M
Last Name:BELCOURT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROGER
Other - Middle Name:M
Other - Last Name:BELCOURT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:1480 TAOS LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-6648
Mailing Address - Country:US
Mailing Address - Phone:775-742-0505
Mailing Address - Fax:
Practice Address - Street 1:350 W 6TH ST STE D2
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4543
Practice Address - Country:US
Practice Address - Phone:775-322-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV54272083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBK083AMedicare PIN
NVCJ0702ZMedicare UPIN
NVCJ070YMedicare UPIN
NVBK083BMedicare PIN