MEDICARE: PAMELA A ROACH DO, PH.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	207Q00000X	Family Medicine Physician	H2346	TX
2	2083X0100X	Occupational Medicine Physician	H2346	TX

General Provider Information

NPI Number	:	1417077801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA A ROACH DO, PH.D

Provider Business Mailing Address
First Line	:	6340 LAKE WORTH BLVD
Second Line	:	#141
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-3602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6340 LAKE WORTH BLVD
Second Line	:	#141
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-3602
Country	:	US
Telephone Number	:	817-882-8700
Fax Number	:

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	02/01/2017

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