Healthcare Provider Details

I. General information

NPI: 1477539740
Provider Name (Legal Business Name): MINDA UNIDAD ROAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MINDA UNIDAD SAGUINSIN ROAN MD

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 05/02/2020
Certification Date: 05/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NW 31ST ST STE 201
LAWTON OK
73505-6100
US

IV. Provider business mailing address

PO BOX 7107
LAWTON OK
73506-1107
US

V. Phone/Fax

Practice location:
  • Phone: 580-585-5549
  • Fax: 580-699-8223
Mailing address:
  • Phone: 580-574-7407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA44814
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: