Provider Demographics
NPI:1023494390
Name:BLOCKER, ROGER DARE (MIHL)
Entity type:Individual
Prefix:PROF
First Name:ROGER
Middle Name:DARE
Last Name:BLOCKER
Suffix:
Gender:M
Credentials:MIHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 ALPINE TRL
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-2422
Mailing Address - Country:US
Mailing Address - Phone:325-656-1482
Mailing Address - Fax:
Practice Address - Street 1:2701 ALPINE TRL
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-2422
Practice Address - Country:US
Practice Address - Phone:325-656-1482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health