Provider Demographics
NPI:1780664169
Name:NARVAEZ, ROGER W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:W
Last Name:NARVAEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1320 FORTINO BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2081
Mailing Address - Country:US
Mailing Address - Phone:719-583-2273
Mailing Address - Fax:719-542-4754
Practice Address - Street 1:1320 FORTINO BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2081
Practice Address - Country:US
Practice Address - Phone:719-583-2273
Practice Address - Fax:719-542-4754
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27161207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01271618Medicaid
CO06618Medicare ID - Type Unspecified
CO01271618Medicaid