Provider Demographics
NPI:1811959778
Name:CLAAR, ROGER VAN OSTRAND (DPM)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:VAN OSTRAND
Last Name:CLAAR
Suffix:
Gender:M
Credentials:DPM
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 2305
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-2305
Mailing Address - Country:US
Mailing Address - Phone:909-578-8271
Mailing Address - Fax:
Practice Address - Street 1:11759 ANNAPOLIS DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-8238
Practice Address - Country:US
Practice Address - Phone:909-578-8271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4153213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6047132Medicaid
CA000E41530Medicaid
CAU73941Medicare UPIN
CA6047132Medicaid