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NPI Code Detail

MEDICARE: MICHAEL L ROACH MD

MEDICARE: MICHAEL L ROACH 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
1207Q00000XFamily Medicine PhysicianMD203385OR
2207Q00000XFamily Medicine PhysicianM7815ID

Other Identifiers

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

General Provider Information

NPI Number : 1528004389
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL L ROACH MD
Provider Business Mailing Address
First Line : 3340 E GOLDSTONE DR
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-1026
Country : US
Telephone Number : 208-302-7500
Fax Number : 208-302-7555
Provider Business Practice Location Address
First Line : 712 AVIATION WAY
Second Line :
City : CALDWELL
State : ID
Zip : 83605-1154
Country : US
Telephone Number : 208-302-7100
Fax Number : 208-302-7155
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2006
Last Update Date : 08/27/2025

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