Individual
JUAN C OLAZAGASTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4348 ELECTRIC RD, ROANOKE, VA 24018-0720
(540) 769-0976
(540) 857-5391
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
(540) 224-5715
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
0101240810
VA
2080P0206X
Pediatric Gastroenterology Physician
ME0057738
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010344701
—
VA
05
—
010383731
—
VA
05
—
55285201
—
FL
Enumeration date
08/29/2006
Last updated
08/09/2022
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