MEDICARE: MARTIN M ROCHE MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06962	OTHER	FL	BLUECROSS OF FLORIDA

General Provider Information

NPI Number	:	1003010380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN M ROCHE MD PA

Provider Business Mailing Address
First Line	:	500 SE 17TH ST
Second Line	:	SUITE 100
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2547
Country	:	US
Telephone Number	:	954-462-7558
Fax Number	:	954-525-5820

Provider Business Practice Location Address
First Line	:	500 SE 17TH ST
Second Line	:	SUITE 100
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2547
Country	:	US
Telephone Number	:	954-462-7558
Fax Number	:	954-525-5820

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MARTIN M ROCHE
Credential	:	MD
Telephone Number	:	954-462-7558

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	07/28/2009

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