Provider Demographics
NPI:1144384934
Name:BELIZAIRE, ROGER (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:BELIZAIRE
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 1:3702 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-4700
Mailing Address - Country:US
Mailing Address - Phone:432-689-7489
Mailing Address - Fax:432-686-0601
Practice Address - Street 1:2004 W OHIO AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5946
Practice Address - Country:US
Practice Address - Phone:432-686-8724
Practice Address - Fax:432-686-0601
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF21692086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0330318-01Medicaid
TX0004402940OtherAETNA
TX00ER12OtherBLUE CROSS BLUE SHIELD
TX00ER12OtherBLUE CROSS BLUE SHIELD
TX0330318-01Medicaid