MEDICARE: DR. DEE ALAN ROACH M.D.

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	207Q00000X	Family Medicine Physician	G5542	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87T821	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275542854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEE ALAN ROACH M.D.

Provider Business Mailing Address
First Line	:	997 W INTERSTATE 20
Second Line	:	FAMILY MEDICAL ASSOCIATES
City	:	COLORADO CITY
State	:	TX
Zip	:	79512-2685
Country	:	US
Telephone Number	:	325-728-2963
Fax Number	:	325-728-2420

Provider Business Practice Location Address
First Line	:	997 W INTERSTATE 20
Second Line	:	FAMILY MEDICAL ASSOCIATES
City	:	COLORADO CITY
State	:	TX
Zip	:	79512-2685
Country	:	US
Telephone Number	:	325-728-2963
Fax Number	:	325-728-2420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	04/28/2014

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