Healthcare Provider Details

I. General information

NPI: 1366655656
Provider Name (Legal Business Name): ROGER GARCIA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4889 SINCLAIR RD STE 112
COLUMBUS OH
43229-5433
US

IV. Provider business mailing address

6699 LAKE TRAIL DR
WESTERVILLE OH
43082-7700
US

V. Phone/Fax

Practice location:
  • Phone: 614-537-5542
  • Fax: 614-505-6258
Mailing address:
  • Phone: 614-402-5687
  • Fax: 614-939-5053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number34.003736
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number34.003736
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: