Healthcare Provider Details

I. General information

NPI: 1205229457
Provider Name (Legal Business Name): ROH MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E 3RD ST
DELTA CO
81416-2815
US

IV. Provider business mailing address

PO BOX 2476
CHEYENNE WY
82003-2476
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-7681
  • Fax:
Mailing address:
  • Phone: 307-638-0300
  • Fax: 307-638-0394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR0051910
License Number StateCO

VIII. Authorized Official

Name: MR. DAEYOUNG ROH
Title or Position: PROVIDER
Credential: MD
Phone: 817-296-9180