Provider Demographics
NPI:1396214706
Name:DEHOYOS, ROGER (APRN)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:DEHOYOS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:CARRIZO SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78834-6278
Mailing Address - Country:US
Mailing Address - Phone:830-876-9458
Mailing Address - Fax:830-876-2411
Practice Address - Street 1:1313 VETERANS AVE STE A
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78839-1651
Practice Address - Country:US
Practice Address - Phone:830-374-9823
Practice Address - Fax:830-374-9858
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139729363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP139729OtherAPRN TX LICENSE #
TX397437001Medicaid