MEDICARE: DR. ROQUE MANUEL ARIAS M.D.

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	208D00000X	General Practice Physician	32981	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376595199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROQUE MANUEL ARIAS M.D.

Provider Business Mailing Address
First Line	:	112 E MAIN ST
Second Line	:
City	:	EAST BEND
State	:	NC
Zip	:	27018-6900
Country	:	US
Telephone Number	:	336-699-2973
Fax Number	:	336-699-2974

Provider Business Practice Location Address
First Line	:	112 E MAIN ST
Second Line	:
City	:	EAST BEND
State	:	NC
Zip	:	27018-6900
Country	:	US
Telephone Number	:	336-699-2973
Fax Number	:	336-699-2974

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	11/23/2010

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