Healthcare Provider Details

I. General information

NPI: 1386610483
Provider Name (Legal Business Name): STEVEN FOREST ROARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 NW 8TH AVE
GAINESVILLE FL
32605-4524
US

IV. Provider business mailing address

4645 NW 8TH AVE
GAINESVILLE FL
32605-4524
US

V. Phone/Fax

Practice location:
  • Phone: 352-264-2500
  • Fax: 352-331-9095
Mailing address:
  • Phone: 352-264-2500
  • Fax: 352-331-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME38483
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME38483
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: