Healthcare Provider Details

I. General information

NPI: 1275604878
Provider Name (Legal Business Name): WARREN PAUL ROQUET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12012 SADDLEHORN LN
MANSFIELD TX
76063-5347
US

IV. Provider business mailing address

3201 UNIVERSITY DR E STE 345
BRYAN TX
77802-3484
US

V. Phone/Fax

Practice location:
  • Phone: 979-492-9268
  • Fax:
Mailing address:
  • Phone: 979-776-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG0026
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG0026
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: