Provider Demographics
NPI:1730290271
Name:SEAGLE, ROGER LEE SR (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:LEE
Last Name:SEAGLE
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14667
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1667
Mailing Address - Country:US
Mailing Address - Phone:828-205-1444
Mailing Address - Fax:
Practice Address - Street 1:224 SHARON AVE NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645
Practice Address - Country:US
Practice Address - Phone:828-572-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24512207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC75100OtherBLUE CROSS BLUE SHIELD
NC1730290271Medicaid
NC75100OtherBLUE CROSS BLUE SHIELD
NC202607Medicare ID - Type Unspecified
NC75100OtherBLUE CROSS BLUE SHIELD