Healthcare Provider Details

I. General information

NPI: 1720064801
Provider Name (Legal Business Name): VERONICA M ROA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 COUNTRY CLUB PKWY
EUGENE OR
97401-6036
US

IV. Provider business mailing address

3774 QUAIL MEADOW WAY
EUGENE OR
97408-5946
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-5001
  • Fax: 541-683-1422
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD23167
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier287186
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: