Provider Demographics
NPI:1265115661
Name:BAYER, ROGER (DACM)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:BAYER
Suffix:
Gender:M
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9189 FONTAINEBLEAU BLVD UNIT 13
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-6311
Mailing Address - Country:US
Mailing Address - Phone:305-753-9815
Mailing Address - Fax:
Practice Address - Street 1:1492 S INDEPENDENCE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5252
Practice Address - Country:US
Practice Address - Phone:757-431-0053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4158171100000X
VA0121001125171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist