Provider Demographics
NPI:1275579336
Name:GARCIA-CAVAZOS, ROGELIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGELIO
Middle Name:
Last Name:GARCIA-CAVAZOS
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 1:4848 NE STALLINGS DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1239
Mailing Address - Country:US
Mailing Address - Phone:936-568-3364
Mailing Address - Fax:936-462-4450
Practice Address - Street 1:4848 NE STALLINGS DR
Practice Address - Street 2:SUITE 205
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1239
Practice Address - Country:US
Practice Address - Phone:936-568-3364
Practice Address - Fax:936-462-4450
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7387207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092953101Medicaid
TX081896501Medicaid
TX163022004Medicaid
TX8K5416OtherBLUE CROSS BLUE SHIELD
TXP00175266OtherPALMETTO GBA
TX451961Medicare PIN
TX8K5416OtherBLUE CROSS BLUE SHIELD
TX092953101Medicaid
TX451960Medicare PIN
TX451962Medicare PIN
TX081896501Medicaid
TXH99423Medicare UPIN
TX00CH47Medicare Oscar/Certification
TX451841Medicare PIN