Healthcare Provider Details

I. General information

NPI: 1376581330
Provider Name (Legal Business Name): TAMMY ELIZABETH ROQUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S HIGHWAY 75
SHERMAN TX
75090-9395
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 903-892-9455
  • Fax: 903-892-4910
Mailing address:
  • Phone: 972-997-8000
  • Fax: 972-437-9605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberH8588
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: