Healthcare Provider Details

I. General information

NPI: 1942266218
Provider Name (Legal Business Name): PLACIDO M ROQUIZ JR. MD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 US HIGHWAY 27 N STE B1
SEBRING FL
33870-7840
US

IV. Provider business mailing address

19105 N US HIGHWAY 41 SUITE 300
LUTZ FL
33549-4206
US

V. Phone/Fax

Practice location:
  • Phone: 863-385-7757
  • Fax: 863-385-3564
Mailing address:
  • Phone: 863-385-7757
  • Fax: 863-385-3564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME48281
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: