Provider Demographics
NPI:1043334071
Name:HARING, ROGER DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DEAN
Last Name:HARING
Suffix:
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 1:29677 BOUQUET CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-1102
Mailing Address - Country:US
Mailing Address - Phone:661-296-7201
Mailing Address - Fax:
Practice Address - Street 1:24515 KANSAS ST
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-1719
Practice Address - Country:US
Practice Address - Phone:661-259-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29170207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10658Medicare ID - Type Unspecified