Provider Demographics
NPI:1356348635
Name:ROLDAN, CARLOS MARIO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MARIO
Last Name:ROLDAN
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 1:9969 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4106
Mailing Address - Country:US
Mailing Address - Phone:210-690-2273
Mailing Address - Fax:210-581-8209
Practice Address - Street 1:9969 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4106
Practice Address - Country:US
Practice Address - Phone:210-690-2273
Practice Address - Fax:210-581-8209
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6273207Q00000X, 2279P3800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2279P3800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPalliative/Hospice
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152038OtherAETNA
422006OtherONE HEALTH
8583769006OtherCIGNA HMO
8583769005OtherCIGNA POS
TX1053605-01Medicaid
161670007OtherPACIFICARE
4188977OtherBLUELINK
737802OtherHUMANA GOLD
85270YOtherBCBS
8583769005OtherCIGNA POS
8583769006OtherCIGNA HMO