Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 171 | MT |
Y | 213ES0103X | Foot & Ankle Surgery | 65 | ND |
N | 213ES0131X | Foot Surgery | DPM.200037 | LA |
NPI | 1063697928 |
---|---|
Provider Name | Roger Steven Racz |
First Address | Minot, ND 58702-5010 |
Second Address | Minot, ND 58701-3880 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2008 |
Last Update Date | 12/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01455275 | (05) | MS |
2120743 | (05) | LA |