Healthcare Provider Details

I. General information

NPI: 1578839304
Provider Name (Legal Business Name): JUAN CAMILO ROJAS-GOMEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST NW 3300
DAYTON OH
45409-2939
US

IV. Provider business mailing address

30 E APPLE ST NW 3300
DAYTON OH
45409-2939
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-8394
  • Fax: 937-208-8388
Mailing address:
  • Phone: 937-208-8394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.123907
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.123907
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.022115
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: