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General NPI Number Information
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NPI Number | 1932215043
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Entity Type | Organization
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Legal Business Name | ROGER C ROQUE MD PA
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 720 N BAY ST SUITE 8
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City | EUSTIS
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State | FL
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Zip | 32726-2964
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Country | US
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Telephone | 352-357-1014
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Fax | 352-357-3130
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Provider Business Mailing Address
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Address Line | PO BOX 1386
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City | EUSTIS
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State | FL
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Zip | 32727-1386
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Country | US
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Telephone | 352-357-1014
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Fax | 352-357-3130
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Authorized Official
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Title or Position | FAMILY PHYSICIAN
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Name | ROGER CAGANDAHAN ROQUE
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Credential | M.D.
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Telephone | 352-357-1014
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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 | ME0070970
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License Number State | FL
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