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General NPI Number Information
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NPI Number | 1750682639
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Entity Type | Organization
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Legal Business Name | MARIO R ROA JR MD PA
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 509 N MAPLE ST
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City | MUENSTER
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State | TX
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Zip | 76252-2425
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Country | US
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Telephone | 940-759-2226
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Fax | 940-759-2385
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Provider Business Mailing Address
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Address Line | PO BOX 370
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City | MUENSTER
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State | TX
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Zip | 76252-0370
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Country | US
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Telephone | 940-759-2226
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Fax | 940-759-2385
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LILLIAN BARKER
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Credential | CPC
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Telephone | 940-759-6126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | N7865
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License Number State | TX
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