Healthcare Provider Details

I. General information

NPI: 1548242324
Provider Name (Legal Business Name): JORGE ALEJANDRO ROQUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S BRYAN RD
MISSION TX
78572-6613
US

IV. Provider business mailing address

2802 SANTA OLIVIA
MISSION TX
78572-7615
US

V. Phone/Fax

Practice location:
  • Phone: 956-580-9000
  • Fax:
Mailing address:
  • Phone: 956-584-8746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberK3841
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: