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General NPI Number Information
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NPI Number | 1104257732
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Entity Type | Individual
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Provider Name | ROGER BARNARD CSFA
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Gender | Male
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Dates
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Enumeration Date | 12/08/2013
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 11320 TEE TIME CIR
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City | NEW PORT RICHEY
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State | FL
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Zip | 34654
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Country | US
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Telephone | 727-494-6863
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Fax |
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Provider Business Mailing Address
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Address Line | 11320 TEE TIME CIR
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City | NEW PORT RICHEY
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State | FL
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Zip | 34654-6221
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Country | US
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Telephone | 727-494-6863
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0136000479
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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