Healthcare Provider Details

I. General information

NPI: 1295041986
Provider Name (Legal Business Name): DANIEL ANDREW ROQUIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 MALL RING RD
SEBRING FL
33870-8515
US

IV. Provider business mailing address

935 MALL RING RD
SEBRING FL
33870-8515
US

V. Phone/Fax

Practice location:
  • Phone: 863-314-4466
  • Fax:
Mailing address:
  • Phone: 863-314-4466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA122899
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM12502
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME142720
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: