Healthcare Provider Details

I. General information

NPI: 1275665663
Provider Name (Legal Business Name): EMILIO MIGUEL ROIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 DEVEREUX DR
VIERA FL
32940-7907
US

IV. Provider business mailing address

8000 DEVEREUX DR
VIERA FL
32940-7907
US

V. Phone/Fax

Practice location:
  • Phone: 321-242-9100
  • Fax: 321-259-0210
Mailing address:
  • Phone: 321-242-9100
  • Fax: 321-259-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0062407
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME0062407
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: