Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | F2169 | TX |
NPI | 1144384934 |
---|---|
Provider Name | Roger Belizaire |
First Address | Midland, TX 79707-4700 |
Second Address | Midland, TX 79701-5946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0004402940 | AETNA (01) | TX |
00ER12 | BLUE CROSS BLUE SHIELD (01) | TX |
0330318-01 | (05) | TX |
C13325 | (02) | TX |