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NPI Code Detail

MEDICARE: DAVID O ROQUE PA

MEDICARE: DAVID O ROQUE 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
1363A00000XPhysician AssistantPA9107791FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255726675
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID O ROQUE PA
Provider Business Mailing Address
First Line : 6360 PRESIDENTIAL CT STE 1
Second Line :
City : FORT MYERS
State : FL
Zip : 33919-3501
Country : US
Telephone Number : 786-377-5643
Fax Number : 786-802-2011
Provider Business Practice Location Address
First Line : 6360 PRESIDENTIAL CT STE 1
Second Line :
City : FORT MYERS
State : FL
Zip : 33919-3501
Country : US
Telephone Number : 786-377-5643
Fax Number : 786-802-2011
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2015
Last Update Date : 04/25/2024

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Directions to “ DAVID O ROQUE PA” Practice Location

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