Healthcare Provider Details

I. General information

NPI: 1376595199
Provider Name (Legal Business Name): ROQUE MANUEL ARIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E MAIN ST
EAST BEND NC
27018-6900
US

IV. Provider business mailing address

112 E MAIN ST
EAST BEND NC
27018-6900
US

V. Phone/Fax

Practice location:
  • Phone: 336-699-2973
  • Fax: 336-699-2974
Mailing address:
  • Phone: 336-699-2973
  • Fax: 336-699-2974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number32981
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: