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General NPI Number Information
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NPI Number | 1972122042
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Entity Type | Individual
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Provider Name | ERIC A. ROACH MD
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Gender | Male
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 909 FULTON ST SE
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City | MINNEAPOLIS
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State | MN
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Zip | 55455-4800
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Country | US
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Telephone | 612-273-8383
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Fax |
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Provider Business Mailing Address
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Address Line | 516 DELAWARE ST SE FL 1
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City | MINNEAPOLIS
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State | MN
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Zip | 55455-0356
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 79639
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License Number State | MN
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