MEDICARE: DR. ROGER M MOCZYGEMBA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	J2212	TX
2	207P00000X	Emergency Medicine Physician	J2212	TX
3	207Q00000X	Family Medicine Physician	J2212	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J2212	OTHER	TX	TX MEDICAL LICENSE

General Provider Information

NPI Number	:	1750382503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER M MOCZYGEMBA MD

Provider Business Mailing Address
First Line	:	1010 NW LOOP 410 STE 100A
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2220
Country	:	US
Telephone Number	:	210-886-8031
Fax Number	:	210-886-8059

Provider Business Practice Location Address
First Line	:	1010 NW LOOP 410 STE 100A
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2220
Country	:	US
Telephone Number	:	210-886-8031
Fax Number	:	210-886-8059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	03/21/2019

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