MEDICARE: COURTNEY ROARK 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	207Q00000X	Family Medicine Physician	H6549	TX

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	:	1861410532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY ROARK MD

Provider Business Mailing Address
First Line	:	9528 WEBB CHAPEL RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4938
Country	:	US
Telephone Number	:	214-357-7311
Fax Number	:	214-352-8150

Provider Business Practice Location Address
First Line	:	9528 WEBB CHAPEL RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4938
Country	:	US
Telephone Number	:	214-357-7311
Fax Number	:	214-352-8150

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	06/01/2010

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Directions to “ COURTNEY ROARK MD” Practice Location

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