Healthcare Provider Details

I. General information

NPI: 1629016241
Provider Name (Legal Business Name): JUAN CARLOS ROIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD BOX 100371
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 918025
ORLANDO FL
32891-8025
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-4195
  • Fax: 352-392-4533
Mailing address:
  • Phone: 352-392-4195
  • Fax: 352-392-4533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME62999
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: