Healthcare Provider Details

I. General information

NPI: 1790488856
Provider Name (Legal Business Name): JOSEPH ROESCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 CAPITAL MEDICAL BLVD
TALLAHASSEE FL
32308-4402
US

IV. Provider business mailing address

4258 RALEIGH WAY
TALLAHASSEE FL
32311-3335
US

V. Phone/Fax

Practice location:
  • Phone: 850-325-5000
  • Fax:
Mailing address:
  • Phone: 703-927-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS23557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: