Healthcare Provider Details

I. General information

NPI: 1194806885
Provider Name (Legal Business Name): LEO ROCERO UY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 12/13/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 CENTRAL AVE
DOVER NH
03820-2526
US

IV. Provider business mailing address

789 CENTRAL AVE
DOVER NH
03820-2526
US

V. Phone/Fax

Practice location:
  • Phone: 603-740-2503
  • Fax: 603-740-2497
Mailing address:
  • Phone: 603-740-2503
  • Fax: 603-740-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12282
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number12282
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: